Doctor Name: | SERGIO MERCADO |
NPI Number: | 1255408571 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 14973 |
Business Practice Address: | 5601 Central Fwy #1811 Wichita Falls, TX - 763056609 |
Business Phone Number: | 9408518042 |
Business Fax Number: | |
Mailing Address: | 5601 Central Fwy, #1811 WICHITA FALLS |
State: | TX |
Postal Code: | 763056609 |
Phone Number: | 9408518042 |
Fax Number: | |
NPI Enumeration Date: | 11/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 14973 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |