Provider Demographics
NPI:1265486633
Name:MERA, BERTHA A (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTHA
Middle Name:A
Last Name:MERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:A
Other - Last Name:TORRES MERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:STE 620 NORTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-523-2597
Mailing Address - Fax:314-590-5948
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 620 NORTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-523-2597
Practice Address - Fax:314-590-5948
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00357508OtherRR MEDICARE
P00357508OtherRR MEDICARE
MOG00525Medicare UPIN
MO000094594Medicare PIN