Provider Demographics
NPI:1073993424
Name:YAMADA, MERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:MERICK
Middle Name:
Last Name:YAMADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE D1190
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6818
Mailing Address - Country:US
Mailing Address - Phone:972-566-5600
Mailing Address - Fax:972-566-5680
Practice Address - Street 1:7777 FOREST LN STE D1190
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6818
Practice Address - Country:US
Practice Address - Phone:972-566-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208000000X208000000X
TXT0394208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1T6153OtherMEDICARE INDIVIDUAL
TX431706701Medicaid