Provider Demographics
NPI:1174605646
Name:MENDEZ, ENRIQUE ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:ANTONIO
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-433-8400
Mailing Address - Fax:
Practice Address - Street 1:501 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5724
Practice Address - Country:US
Practice Address - Phone:337-312-8619
Practice Address - Fax:337-312-8614
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024079207RR0500X
LAMD.024079207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485055Medicaid
LAP01358480Medicare PIN
LA4A523Medicare PIN
LAH44718Medicare UPIN
LA4A523CS87Medicare PIN