Individual
RAUL MENDOZA-AYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 288-8000
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
42580
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104386082
—
MI
01
—
290013377
RAILROAD
WI
05
—
34036200
—
WI
Enumeration date
06/24/2006
Last updated
01/19/2024
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