Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 171679-1205 | UT |
NPI | 1063452050 |
---|---|
Provider Name | Dr. Steven W Merrell |
First Address | Murray, UT 84123-5632 |
Second Address | Murray, UT 84107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 31/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07831 | (05) | UT |
E92108 | (02) | UT |