Provider Demographics
NPI:1497999437
Name:SANTOS, JUAN MERCADO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MERCADO
Last Name:SANTOS
Suffix:
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:HWY49W MS. DEPT.OFCORRECTION
Mailing Address - Street 2:POBOX237
Mailing Address - City:PARCHMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38738
Mailing Address - Country:US
Mailing Address - Phone:662-745-6611
Mailing Address - Fax:662-745-9994
Practice Address - Street 1:HWY49W MS. DEPT OF CORRECTION
Practice Address - Street 2:PODRAWER E
Practice Address - City:PARCHMAN
Practice Address - State:MS
Practice Address - Zip Code:38738
Practice Address - Country:US
Practice Address - Phone:662-745-6611
Practice Address - Fax:662-745-9994
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS270-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice