MEDICARE: CHRISTOPHER D. MERCADO M.D.

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	207Q00000X	Family Medicine Physician	15352	NV

General Provider Information

NPI Number	:	1629377379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER D. MERCADO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	702-616-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 BLUE DIAMOND RD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7602
Country	:	US
Telephone Number	:	702-616-5801
Fax Number	:

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	08/11/2022

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