Individual
DR. EDGAR A D MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1484 LAKESIDE DRIVE, JACKSON, KY 41339-6555
(606) 666-9950
(606) 666-9136
Mailing address
PO BOX 690, BEATTYVILLE, KY 41311-0690
(606) 464-0151
(606) 464-0152
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
33465
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467417691
MEDICAID FQHC GROUP
KY
05
—
64343650
—
KY
Enumeration date
09/15/2006
Last updated
03/13/2020
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