Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 230051 | MA |
NPI | 1316986904 |
---|---|
Provider Name | Gustavo A Mercier JR. |
First Address | Boston, MA 02119-2560 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110075061A | (05) | MA |