Provider Demographics
NPI:1073928768
Name:DIAZ-MERCADO, GUSTAVO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:A
Last Name:DIAZ-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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-464-8284
Practice Address - Fax:504-464-8277
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133375207L00000X
FL20598208800000X
LA310142207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20598OtherFLORIDA DEPARTMENT OF HEALTH