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NPI Code Detail

MEDICARE: CRAIG RANDALL MIERCORT M.D.

MEDICARE: CRAIG RANDALL MIERCORT 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
12085R0001XRadiation Oncology PhysicianME87496FL

Other Identifiers

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

General Provider Information

NPI Number : 1578532750
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG RANDALL MIERCORT M.D.
Provider Business Mailing Address
First Line : 6600 66TH ST N
Second Line :
City : PINELLAS PARK
State : FL
Zip : 33781-5040
Country : US
Telephone Number : 727-343-0600
Fax Number : 727-344-6163
Provider Business Practice Location Address
First Line : 6600 66TH ST N
Second Line :
City : PINELLAS PARK
State : FL
Zip : 33781-5040
Country : US
Telephone Number : 727-343-0600
Fax Number : 727-344-6163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 06/24/2020

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