Provider Demographics
NPI:1366444051
Name:MERCADO, CARLOS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:ALBERTO
Other - Last Name:MERCADO NEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:624 S 1000 E STE 103
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5902
Mailing Address - Country:US
Mailing Address - Phone:435-652-1135
Mailing Address - Fax:435-652-1190
Practice Address - Street 1:624 S 1000 E STE 103
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5902
Practice Address - Country:US
Practice Address - Phone:435-652-1135
Practice Address - Fax:435-652-1190
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6787613-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1366444051Medicaid