Provider Demographics
NPI:1508824335
Name:MERCER, LEO C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:C
Last Name:MERCER
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 1:1600 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5620
Mailing Address - Country:US
Mailing Address - Phone:940-723-8465
Mailing Address - Fax:940-766-1965
Practice Address - Street 1:1600 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5620
Practice Address - Country:US
Practice Address - Phone:940-723-8465
Practice Address - Fax:940-766-1965
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9162208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124085OtherPTAN
TX133224901Medicaid
TXTXB124085OtherPTAN
TXC19310Medicare UPIN