Provider Demographics
NPI:1235127960
Name:MERCADO, ZENON III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ZENON
Middle Name:
Last Name:MERCADO
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 LAMPLIGHT
Mailing Address - Street 2:
Mailing Address - City:ALLEYTON
Mailing Address - State:TX
Mailing Address - Zip Code:78935-2152
Mailing Address - Country:US
Mailing Address - Phone:979-256-7387
Mailing Address - Fax:
Practice Address - Street 1:110 SHULT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3016
Practice Address - Country:US
Practice Address - Phone:979-253-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153636907Medicaid
TX153636908Medicaid
TX00C21TOtherBLUE CROSS BLUE SHIELD
TX288017YK6UMedicare PIN