Provider Demographics
NPI:1316919228
Name:MERCADO, MANUEL J (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:J
Last Name:MERCADO
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 1:502 S CAGE BLVD
Mailing Address - Street 2:PHARR
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5449
Mailing Address - Country:US
Mailing Address - Phone:956-702-1013
Mailing Address - Fax:956-781-5196
Practice Address - Street 1:502 S CAGE BLVD
Practice Address - Street 2:PHARR
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5449
Practice Address - Country:US
Practice Address - Phone:956-702-1013
Practice Address - Fax:956-781-5196
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087ETOtherBCBS
TXP00191876OtherRAILROAD MEDICARE
TX030866002Medicaid
TX0087ETOtherBLUE CROSS BLUE SHIELD
TXH17629Medicare UPIN
TX0087ETOtherBCBS