Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 45464 | WI |
NPI | 1003851049 |
---|---|
Provider Name | David B Merritt |
First Address | Mancos, CO 81328-9170 |
Second Address | Durango, CO 81301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 13/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34480700 | (05) | WI |
86675265 | (05) | CO |
I08578 | (02) |