Provider Demographics
NPI:1386625002
Name:MENDOZA, ERNEST J (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:J
Last Name:MENDOZA
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 1:21083 WILLIAMS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-2380
Mailing Address - Country:US
Mailing Address - Phone:713-299-5727
Mailing Address - Fax:
Practice Address - Street 1:22710 PROFESSIONAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6008
Practice Address - Country:US
Practice Address - Phone:281-312-8521
Practice Address - Fax:281-359-7971
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10034812OtherAMERIGROUP COMMUNITY CARE
TXP00235710OtherRAILROAD MEDICARE
TX172500401Medicaid
TX8R9840OtherBLUE CROSS BLUE SHIELD
TX8E0470Medicare ID - Type Unspecified
TXP00235710OtherRAILROAD MEDICARE
TXTXB141756Medicare PIN