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General NPI Number Information
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NPI Number | 1053508283
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Entity Type | Organization
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Legal Business Name | GREG J. MERCURIO, MD, PA
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 1720 STATE ROAD 44
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8339
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Country | US
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Telephone | 386-427-8008
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Fax | 386-402-4309
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Provider Business Mailing Address
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Address Line | 1720 STATE ROAD 44
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8339
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Country | US
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Telephone | 386-427-8008
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Fax | 386-423-0355
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY JAMES MERCURIO
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Credential | MD
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Telephone | 386-427-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0060051
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License Number State | FL
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