Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | G9162 | TX |
NPI | 1508824335 |
---|---|
Provider Name | Dr. Leo C Mercer |
First Address | Wichita Falls, TX 76301-5620 |
Second Address | Wichita Falls, TX 76301-5620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133224901 | (05) | TX |
C19310 | (02) | TX |
TXB124085 | PTAN (01) | TX |