Individual
IVAN MENEZES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 W PLYMOUTH AVE, DELAND, FL 32720-3236
(386) 943-4522
Mailing address
PO BOX 9430, DAYTONA BEACH, FL 32120-9430
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
ME78170
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58836
BC BS
FL
Enumeration date
11/22/2005
Last updated
03/24/2008
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