Healthcare Provider Details

I. General information

NPI: 1326233602
Provider Name (Legal Business Name): ALFREDO EDGARDO MERCADO-QUINONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 SW 36TH LN
OCALA FL
34474-9449
US

IV. Provider business mailing address

4980 SW 36TH LN
OCALA FL
34474-9449
US

V. Phone/Fax

Practice location:
  • Phone: 939-539-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME127312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: