Individual
MILTON T. MENDENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 HEALTH PARK BLVD, ATTN: RADIOLOGY DEPARTMENT, SAINT AUGUSTINE, FL 32086-5784
(904) 819-4398
(904) 819-4976
Mailing address
400 HEALTH PARK BLVD, ATTN: RADIOLOGY DEPARTMENT, SAINT AUGUSTINE, FL 32086-5784
(904) 819-4398
(904) 819-4976
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME48034
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272439100
—
FL
01
—
300029640
RAILROAD MEDICARE
FL
Enumeration date
03/08/2006
Last updated
06/07/2012
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