Provider Demographics
NPI:1205988540
Name:MERCER, JOHN WHITNEY JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WHITNEY
Last Name:MERCER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4209
Mailing Address - Country:US
Mailing Address - Phone:970-249-6737
Mailing Address - Fax:970-252-0112
Practice Address - Street 1:4424 E FLAMINGO AVE STE 200
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9300
Practice Address - Country:US
Practice Address - Phone:208-302-1400
Practice Address - Fax:208-302-1455
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL023779207V00000X
COCDR.0000210207V00000X
ID3971468207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAL023779OtherSTATE LICENSE
CO9000166884Medicaid
LA1487163Medicaid
LA5H553Medicare ID - Type Unspecified