Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | PA9111604 | FL |
NPI | 1144704800 |
---|---|
Provider Name | David Robert Merkle |
First Address | Fort Myers, FL 33912-7131 |
Second Address | Fort Myers, FL 33912-7131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2018 |
Last Update Date | 19/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PA9111604 | LICENSE NUMBER (01) | FL |