Provider Demographics
NPI:1104907005
Name:MERCER, BRADLEY S (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:MERCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3200 RIVERFRONT DR
Practice Address - Street 2:STE 103
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6570
Practice Address - Country:US
Practice Address - Phone:817-336-3800
Practice Address - Fax:817-335-9454
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137345801Medicaid
1750369203OtherGRP NPI NUMBER
TX177056201Medicaid
TX3877622OtherCIGNA PIN
TX1640307OtherFIRSTHEALTH PIN
TXMERBG08198OtherCCHIP PIN
TX045288002Medicaid
TX05288001Medicaid
TX130383100OtherFIRSTCARE PIN
TX86X593OtherBCBSTX IND PIN
TX1363305OtherUHC PIN
TX5522021OtherAETNA PIN
TX00U87ZOtherBCBSTX GRP PIN
TX00U87ZOtherBCBSTX GRP PIN
TX1640307OtherFIRSTHEALTH PIN
G08198Medicare UPIN
TX137345801Medicaid
TX00480RMedicare PIN