MEDICARE: ELLOITT MERCER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A23410	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174576771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLOITT MERCER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2520
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92654-2520
Country	:	US
Telephone Number	:	949-263-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	24451 HEALTH CENTER DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3689
Country	:	US
Telephone Number	:	949-452-3573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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