MEDICARE: DR. CONNIE K. 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	207Q00000X	Family Medicine Physician	ME69236	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080112357	OTHER	FL	RAILROAD MEDICARE NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1730128034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE K. MERCER M.D.

Provider Business Mailing Address
First Line	:	201 LAGRANDE BLVD
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-1303
Country	:	US
Telephone Number	:	352-753-0606
Fax Number	:	352-753-0650

Provider Business Practice Location Address
First Line	:	201 LAGRANDE BLVD
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-1303
Country	:	US
Telephone Number	:	352-753-0606
Fax Number	:	352-753-0650

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	02/06/2023

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