Provider Demographics
NPI:1235196957
Name:MERCER, JOHN WESLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:MERCER
Suffix:JR
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 1:600 COOPER DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3970
Mailing Address - Country:US
Mailing Address - Phone:972-442-7325
Mailing Address - Fax:972-442-8348
Practice Address - Street 1:600 COOPER DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3970
Practice Address - Country:US
Practice Address - Phone:972-442-7325
Practice Address - Fax:972-442-8348
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164914703Medicaid
TX8K8605Medicare PIN
TXI03812Medicare UPIN
TXP00196361Medicare PIN