Provider Demographics
NPI:1427020676
Name:MANUEL J MERCADO MD PA
Entity Type:Organization
Organization Name:MANUEL J MERCADO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-702-1013
Mailing Address - Street 1:502 S CAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5449
Mailing Address - Country:US
Mailing Address - Phone:956-702-1013
Mailing Address - Fax:956-781-5196
Practice Address - Street 1:502 S CAGE BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5449
Practice Address - Country:US
Practice Address - Phone:956-702-1013
Practice Address - Fax:956-781-5196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC8176OtherRAILROAD MEDICARE
TX0033QFOtherBCBS
0087GTOtherBLUE CROSS BLUE SHIELD
TX155460201Medicaid
TX00339UMedicare PIN