Provider Demographics
NPI:1801844212
Name:MERCADO, JAIRO L (MD)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:L
Last Name:MERCADO
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 1:874 GREY FOX CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9036
Mailing Address - Country:US
Mailing Address - Phone:956-546-0190
Mailing Address - Fax:
Practice Address - Street 1:3354 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3226
Practice Address - Country:US
Practice Address - Phone:956-548-6666
Practice Address - Fax:956-548-6667
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0419208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141341106Medicaid
TX141341106Medicaid
TX8F2711Medicare ID - Type Unspecified