Provider Demographics
NPI:1194716894
Name:MERCED, JORGE M (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:M
Last Name:MERCED
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 11626
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-6626
Mailing Address - Country:US
Mailing Address - Phone:253-565-9765
Mailing Address - Fax:253-584-6544
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:ST CLARE HOSPITAL
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-581-6403
Practice Address - Fax:253-584-6544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020359207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1079946Medicaid
WA1079946Medicaid