Individual
MOISES A MENENDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 HOSPTIAL DRIVE, MAGNOLIA, AR 71753
(870) 235-3600
Mailing address
PO BOX 629, MAGNOLIA, AR 71754
(870) 235-3600
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R2525
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106120001
—
AR
05
—
195228501
—
TX
01
—
53626
BLUE CROSS
AR
01
—
8AL616
BCBS
TX
Enumeration date
09/19/2005
Last updated
06/18/2010
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