Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0103000848 | VA |
NPI | 1255478160 |
---|---|
Provider Name | Dr. Frank Mercer III |
First Address | Virginia Beach, VA 23464-2227 |
Second Address | Norfolk, VA 23504-2840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009300066 | (05) | VA |
095891 | BLUE CROSS BLUE SHIELD (01) | VA |
U17415 | (02) | VA |