Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME 73229 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME 73229 | FL |
NPI | 1033139100 |
---|---|
Provider Name | Carlos Mercado |
First Address | Lake Mary, FL 32746-1414 |
Second Address | Lake Mary, FL 32746-1413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 06/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259497800 | (05) | FL |
G37545 | (02) | FL |