Basic Information
| Provider Information | |||||||||
| NPI: | 1770840126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERCER | ||||||||
| FirstName: | SHELLY | ||||||||
| MiddleName: | BOWLES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 268838 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731268838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186194400 | ||||||||
| FaxNumber: | 9186194801 | ||||||||
| Practice Location | |||||||||
| Address1: | 4444 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741352527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186194400 | ||||||||
| FaxNumber: | 9186194801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 33525 | OK | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 200775570A | 05 | OK | MEDICAID |