Provider Demographics
NPI:1649224098
Name:MERCER, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
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 1:9209 COLIMA RD STE 4400
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1823
Mailing Address - Country:US
Mailing Address - Phone:562-264-4297
Mailing Address - Fax:562-321-9238
Practice Address - Street 1:9209 COLIMA RD STE 4400
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1823
Practice Address - Country:US
Practice Address - Phone:833-260-3358
Practice Address - Fax:562-321-9238
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080109958OtherRAILROAD
P00367004OtherRAILROAD
CA00A550200Medicaid
00A550200OtherBLUE SHIELD ID #
065729OtherHEALTH NET ID #
00A550200OtherBLUE SHIELD ID #
CAWA55020BMedicare PIN
CA00A550200Medicaid