Provider Demographics
NPI:1215964697
Name:MENDELBLATT, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:MENDELBLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4813
Mailing Address - Country:US
Mailing Address - Phone:727-822-6763
Mailing Address - Fax:727-821-0649
Practice Address - Street 1:600 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4813
Practice Address - Country:US
Practice Address - Phone:727-822-6763
Practice Address - Fax:727-821-0649
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79536207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266967600Medicaid
FLK4565OtherMEDICARE GROUP
FLK4565OtherMEDICARE GROUP
FL266967600Medicaid