Provider Demographics
NPI:1992741078
Name:MENEZES, ALLISON V (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:V
Last Name:MENEZES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1931
Mailing Address - Country:US
Mailing Address - Phone:941-748-1818
Mailing Address - Fax:941-746-1055
Practice Address - Street 1:217 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1931
Practice Address - Country:US
Practice Address - Phone:941-748-1818
Practice Address - Fax:941-746-1055
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065322207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00397350OtherRAILROAD MEDICARE
FL379085100Medicaid
G17385Medicare UPIN
27863Medicare ID - Type Unspecified