Basic Information
| Provider Information | |||||||||
| NPI: | 1700898962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERCER | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | RANDALL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 N US HIGHWAY 87 | ||||||||
| Address2: | |||||||||
| City: | BIG SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797200283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322678216 | ||||||||
| FaxNumber: | 4322687790 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 HIGHWAY 87 N | ||||||||
| Address2: | |||||||||
| City: | BIG SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797200283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322678216 | ||||||||
| FaxNumber: | 4322687790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | E8722 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1381873-13 | 05 | TX | MEDICAID |