Provider Demographics
NPI:1548246291
Name:MENENDEZ, JOSE C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:C
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3358 W SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2706
Mailing Address - Country:US
Mailing Address - Phone:407-343-0006
Mailing Address - Fax:407-343-0881
Practice Address - Street 1:3358 W SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2706
Practice Address - Country:US
Practice Address - Phone:407-343-0006
Practice Address - Fax:407-343-0881
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN265208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI31082Medicare UPIN