Provider Demographics
NPI:1457435034
Name:MERCER, JEANNETTE YVONNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:YVONNE
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 1:13445 VOYAGER PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7648
Mailing Address - Country:US
Mailing Address - Phone:719-219-0333
Mailing Address - Fax:719-219-0320
Practice Address - Street 1:2127 E HARMONY RD STE 140
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3406
Practice Address - Country:US
Practice Address - Phone:970-297-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27598207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275981Medicaid
COC811204Medicare PIN
CO01275981Medicaid
COD24969Medicare UPIN