Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME0079981 | FL |
NPI | 1073610515 |
---|---|
Provider Name | Roberto A Mercado |
First Address | Sarasota, FL 34239-2900 |
Second Address | Sarasota, FL 34239-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 22/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259689000 | (05) | FL |
35640 | BCBS FL (01) | FL |
H16948 | (02) |