Provider Demographics
NPI:1083067110
Name:RODRIGUEZ MERCADO, ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:RODRIGUEZ 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 1:4715 S FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2101
Mailing Address - Country:US
Mailing Address - Phone:863-209-7004
Mailing Address - Fax:863-274-3542
Practice Address - Street 1:4715 S FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2101
Practice Address - Country:US
Practice Address - Phone:863-209-7004
Practice Address - Fax:863-274-3542
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147354207R00000X
PR32310-R390200000X
PR21562390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine