Provider Demographics
NPI:1891967089
Name:JASON R MERCER MD PA
Entity Type:Organization
Organization Name:JASON R MERCER MD PA
Other - Org Name:SIGNATURE HEALTHCARE OF VOLUSIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:REED
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-322-5200
Mailing Address - Street 1:801 BEVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1860
Mailing Address - Country:US
Mailing Address - Phone:386-322-5200
Mailing Address - Fax:386-767-0062
Practice Address - Street 1:801 BEVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1860
Practice Address - Country:US
Practice Address - Phone:386-322-5200
Practice Address - Fax:386-767-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0251Medicare PIN