Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | J8315 | TX |
NPI | 1023082062 |
---|---|
Provider Name | Dr. Bradley S Merritt |
First Address | Dallas, TX 75284-6098 |
Second Address | Tyler, TX 75701-8350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 13/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130579906 | (05) | TX |
G13754 | (02) |