Provider Demographics
NPI:1477594620
Name:MERCER, LANE JAY (MD)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:JAY
Last Name:MERCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-898-9804
Mailing Address - Fax:407-898-9805
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-898-9804
Practice Address - Fax:407-898-9805
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME89606207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49013OtherBLUE SHIELD CODE
FLDF2563OtherRAILROAD MEDICARE
FLC39281Medicare UPIN
FLDF2563OtherRAILROAD MEDICARE