MEDICARE: BENJAMIN MENDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R0450	TX

General Provider Information

NPI Number	:	1992184626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MENDEZ M.D.

Provider Business Mailing Address
First Line	:	7716 LAKE JUNE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1650
Country	:	US
Telephone Number	:	214-398-8801
Fax Number	:	214-439-8888

Provider Business Practice Location Address
First Line	:	7716 LAKE JUNE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1650
Country	:	US
Telephone Number	:	214-398-8801
Fax Number	:	214-439-8888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	07/02/2021

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