Provider Demographics
NPI:1144227869
Name:MERCADO, LUIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1895
Mailing Address - Country:US
Mailing Address - Phone:787-892-4357
Mailing Address - Fax:787-659-7120
Practice Address - Street 1:AVE. INTERAMERICANA #153
Practice Address - Street 2:ESQ CHILIN QUINONES EDIF SAN JOSE #3
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-4357
Practice Address - Fax:787-659-7120
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11063207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660564140OtherCOSVI
PR212828OtherUTI
PR11063OtherLICENCIA
PR6830010OtherHUMANA
PR7071OtherINTERNATIONAL MEDICAL CAR
PRPE4493OtherPAN AMERICAN LIFE
PR83684OtherTRILES
PR064911OtherCRUZ AZUL
PR100003WOtherMEDICARE Y MUCHO MAS
PRDM106658OtherASSMCA
PR1066AOtherPREFERED MEDICARE CHOICE
PR1066AOtherPREFERED MEDICARE CHOICE
PR83684OtherTRILES
PR7071OtherINTERNATIONAL MEDICAL CAR