Basic Information
| Provider Information | |||||||||
| NPI: | 1871569178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 JOEL DR | ||||||||
| Address2: | BLANCHFIELD ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FT. CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 JOEL DR | ||||||||
| Address2: | BLANCHFIELD ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FT. CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988372 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | K3923 | TX | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.