Provider Demographics
NPI:1467681833
Name:FABREGAS MERCADO, JESUS CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:CARLOS
Last Name:FABREGAS MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:CARLOS
Other - Last Name:FABREGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-0278
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1750 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4611
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-276-0765
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136687207RH0000X, 207RH0000X, 207RX0202X
MT36224207RH0003X
FLTRN14215390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111579600Medicaid