Healthcare Provider Details

I. General information

NPI: 1497767255
Provider Name (Legal Business Name): MARLENE MERCADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SE OSCEOLA ST
STUART FL
34994-2505
US

IV. Provider business mailing address

421 SE OSCEOLA ST P.O. BOX 868
STUART FL
34994-2505
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-0338
  • Fax: 772-287-1139
Mailing address:
  • Phone: 772-286-0338
  • Fax: 772-297-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME78422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: