Organization
LUIS T MENENDEZ MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS TERRY MENENDEZ M.D. (PRESIDENT)
(813) 879-8436
Entity
Organization
Contact information
Practice address
3011 W SWANN AVE, TAMPA, FL 33609-4059
(813) 879-8436
(813) 878-2405
Mailing address
3011 W SWANN AVE, TAMPA, FL 33609-4059
(813) 879-8436
(813) 878-2405
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
24434
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0290339
CLIA
FL
05
—
204969400
—
FL
01
—
3211253
AETNA
FL
01
—
406073185
RAILROAD MEDICARE
FL
Enumeration date
07/04/2006
Last updated
11/08/2007
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