Healthcare Provider Details

I. General information

NPI: 1356508683
Provider Name (Legal Business Name): RICHARD F MERCADO DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W OAKLAND PARK BLVD SUITE 107
LAUDERDALE LAKES FL
33313-7500
US

IV. Provider business mailing address

4900 W OAKLAND PARK BLVD SUITE 107
LAUDERDALE LAKES FL
33313-7500
US

V. Phone/Fax

Practice location:
  • Phone: 919-425-1565
  • Fax:
Mailing address:
  • Phone: 919-425-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberPO2250
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2250
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2250
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO2250
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD F MERCADO
Title or Position: PRESIDENT
Credential: DPM
Phone: 919-425-1565