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Individual
DR. ROBERT MICHAEL MENA
Active
Individual
DR. ROBERT MICHAEL MENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8898
ID
207Q00000X
Family Medicine Physician
T0566
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010144054
BLUE SHIELD OF IDAHO
ID
01
—
000010144342
BLUE SHIELD OF IDAHO
ID
01
—
1111689
MEDICARE
ID
01
—
55392
BLUE CROSS
ID
01
—
553925
BLUE CROSS OF IDAHO
ID
05
—
806670100
—
ID
01
—
820227163B004
TRICARE
ID
01
—
820227163G041
TRICARE
ID
01
—
J9430
BLUE CROSS OF IDAHO
ID
Enumeration date
02/18/2007
Last updated
03/02/2022
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