Healthcare Provider Details

I. General information

NPI: 1477594620
Provider Name (Legal Business Name): LANE JAY MERCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 210
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 210
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-9804
  • Fax: 407-898-9805
Mailing address:
  • Phone: 407-898-9804
  • Fax: 407-898-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME89606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: