Provider Demographics
NPI:1730128034
Name:MERCER, CONNIE K (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:K
Last Name:MERCER
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 1:201 LAGRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-1303
Mailing Address - Country:US
Mailing Address - Phone:352-753-0606
Mailing Address - Fax:352-753-0650
Practice Address - Street 1:201 LAGRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1303
Practice Address - Country:US
Practice Address - Phone:352-753-0606
Practice Address - Fax:352-753-0650
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080112357OtherRAILROAD MEDICARE NUMBER
FL257176500Medicaid
FL257176500Medicaid
FL28893WMedicare PIN
FL080112357OtherRAILROAD MEDICARE NUMBER