Provider Demographics
NPI:1982149100
Name:MARY K MERCER
Entity type:Organization
Organization Name:MARY K MERCER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-942-5513
Mailing Address - Street 1:5700 N PORTLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1662
Mailing Address - Country:US
Mailing Address - Phone:400-942-5513
Mailing Address - Fax:405-943-1661
Practice Address - Street 1:5700 N PORTLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1662
Practice Address - Country:US
Practice Address - Phone:405-942-5513
Practice Address - Fax:405-943-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-24
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF45029Medicare UPIN