MEDICARE: DR. CHARLES S MERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	56773	FL
2	207QS0010X	Sports Medicine (Family Medicine) Physician	56773	FL
3	207Q00000X	Family Medicine Physician	A47852	CA
4	207L00000X	Anesthesiology Physician	A47852	CA

General Provider Information

NPI Number	:	1598789356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES S MERSON MD

Provider Business Mailing Address
First Line	:	1409 S LAMAR ST APT 705
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-6839
Country	:	US
Telephone Number	:	561-723-4235
Fax Number	:	972-913-4371

Provider Business Practice Location Address
First Line	:	1409 S LAMAR ST APT 705
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-6839
Country	:	US
Telephone Number	:	561-723-4235
Fax Number	:	972-913-4371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/01/2020

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