Healthcare Provider Details

I. General information

NPI: 1467816058
Provider Name (Legal Business Name): RENEE MERCER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

4375 E IRMA LN
PHOENIX AZ
85050-4312
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-0000
  • Fax:
Mailing address:
  • Phone: 760-807-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1016096
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number408722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: