MEDICARE: DR. RAFAEL L MERCADO DDS

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	1223G0001X	General Practice Dentistry	17101	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306173554	OTHER	TX	TYPE 2 BUSINESS NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1376774851	OTHER	TX	NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376633479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL L MERCADO DDS

Provider Business Mailing Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE 225
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-732-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE 225
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-732-4570
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/08/2014

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