Provider Demographics
NPI:1851349518
Name:MENDOZA, JOSE ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERTO
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 1:2770 CAPITAL MEDICAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8419
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-671-2766
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8419
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-671-2766
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261662900Medicaid
FLH24806Medicare UPIN
FL35634YMedicare Oscar/Certification