MEDICARE: JOHN MERSCH III 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	208000000X	Pediatrics Physician	G40887	CA

General Provider Information

NPI Number	:	1588769558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MERSCH III M.D.

Provider Business Mailing Address
First Line	:	23321 EL TORO RD
Second Line	:	SUITES F&G
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4825
Country	:	US
Telephone Number	:	949-770-0513
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 CORPORATE DR
Second Line	:	SUITE 250
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-2135
Country	:	US
Telephone Number	:	949-388-1798
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/13/2012

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