Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD15682 | TN |
Y | 111NI0900X | Internist | MD15682 | TN |
N | 207RA0401X | Internist - Addiction Medicine | MD15682 | TN |
NPI | 1467455287 |
---|---|
Provider Name | Dr. Bryan Hale Merrick |
First Address | Mc Kenzie, TN 38201-1649 |
Second Address | Mc Kenzie, TN 38201-1649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 01/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3011498 | (05) | TN |
3380640 | (05) | TN |
A97564 | (02) | TN |
MD15682 | MEDICAL LICENSE NUMBER (01) | TN |