Provider Demographics
NPI:1386643567
Name:MENDELSON, DAVID B (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:B
Other - Last Name:MENDELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1010 E MCDOWELL RD STE LL1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2606
Mailing Address - Country:US
Mailing Address - Phone:602-956-1250
Mailing Address - Fax:623-321-8620
Practice Address - Street 1:1492 S MILL AVE STE 301
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5676
Practice Address - Country:US
Practice Address - Phone:480-894-5550
Practice Address - Fax:480-894-9469
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3728207Y00000X, 207YX0905X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ698251Medicaid
AZ70955Medicare ID - Type Unspecified
AZE54243Medicare UPIN