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General NPI Number Information
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NPI Number | 1700102704
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Entity Type | Individual
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Provider Name | MIGUEL ANGEL MERCADO MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 506 GRAHAM DR STE 150
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City | TOMBALL
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State | TX
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Zip | 77375-3346
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Country | US
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Telephone | 281-351-5174
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Fax | 281-381-5172
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Provider Business Mailing Address
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Address Line | PO BOX 911230
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City | DALLAS
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State | TX
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Zip | 75391-1230
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Country | US
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Telephone | 972-997-8000
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Fax | 972-234-0813
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | BP10034440
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | P8603
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License Number State | TX
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