Provider Demographics
NPI:1063770592
Name:MERCADO IRIZARRY, ALEX XAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:XAVIER
Last Name:MERCADO IRIZARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 E COMMERCIAL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3737
Mailing Address - Country:US
Mailing Address - Phone:954-928-1778
Mailing Address - Fax:954-771-1402
Practice Address - Street 1:1900 E COMMERCIAL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3737
Practice Address - Country:US
Practice Address - Phone:954-928-1778
Practice Address - Fax:954-771-1402
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19644207R00000X
FLME136451207RG0100X
PR29692-R207R00000X
PR31652-R207RG0100X
PR31281-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine