Provider Demographics
NPI:1366540023
Name:GONZALES MERCADO, MARY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:GONZALES MERCADO
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:G
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:713-673-9000
Mailing Address - Fax:855-895-8495
Practice Address - Street 1:1910 JOHN RALSTON RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77013-5531
Practice Address - Country:US
Practice Address - Phone:713-673-9000
Practice Address - Fax:855-895-8185
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4350207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366540023Medicaid
10912070OtherCAQH
1366540023OtherNPI
TX8K9122Medicare PIN
10912070OtherCAQH
1366540023OtherNPI