Provider Demographics
NPI:1023033214
Name:MONTES-MERCADO, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:MONTES-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:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0858
Mailing Address - Country:US
Mailing Address - Phone:787-884-2888
Mailing Address - Fax:787-884-2888
Practice Address - Street 1:#1 CALLE JOSE CANDELAS, SUITE 108, SECTOR LA LOMITA
Practice Address - Street 2:MANATI MEDICAL PLAZA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-2888
Practice Address - Fax:787-884-2888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7834207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8-2298Medicare ID - Type Unspecified