Provider Demographics
NPI:1710912761
Name:COOPER-MERCADO, RACHEL LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:COOPER-MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 RYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8075
Mailing Address - Country:US
Mailing Address - Phone:863-402-7555
Mailing Address - Fax:863-402-4625
Practice Address - Street 1:37 RYANT BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8075
Practice Address - Country:US
Practice Address - Phone:863-402-7555
Practice Address - Fax:863-402-4625
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000663719Medicaid
FL51010OtherBCBS
160052727OtherRAILROAD MEDICARE
FL261724200Medicaid
FL51010ZMedicare PIN
FL000663719Medicaid
FL51010OtherBCBS