Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22096 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D2373 | PR |
NPI | 1003812298 |
---|---|
Provider Name | Dr. Nelson A Mercado |
First Address | Aguada, PR 00602-0684 |
Second Address | Aguadilla, PR 00603-5643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95051 | (02) | PR |