Individual
JOSE E MENDOZA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1813 NAGEL RD STE 500, AVON, OH 44011-6401
(440) 937-4600
(440) 937-4605
Mailing address
PO BOX 636643, CINCINNATI, OH 45263-6461
(440) 989-3801
(440) 960-0264
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35-06-6480-M
OH
207R00000X
Internal Medicine Physician
Primary
35066480
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0236248
—
OH
05
—
0974594
—
OH
05
—
3025372
—
OH
01
—
5619197341C96
BLUECROSS BLUESHIELD
OH
Enumeration date
01/23/2006
Last updated
08/29/2022
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