Provider Demographics
NPI:1992807432
Name:MERCER, MARY KATHRYN I (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHRYN
Last Name:MERCER
Suffix:I
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:MERCER
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5622 N PORTLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2096
Mailing Address - Country:US
Mailing Address - Phone:405-942-5513
Mailing Address - Fax:405-943-1661
Practice Address - Street 1:5622 N PORTLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2096
Practice Address - Country:US
Practice Address - Phone:405-942-5513
Practice Address - Fax:405-943-1661
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSOCIAL SECURITY NUMBER