Provider Demographics
NPI:1083696074
Name:MERRITT, PHILIP ORMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ORMOND
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 SUGAR LOAF DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3919
Mailing Address - Country:US
Mailing Address - Phone:818-790-7066
Mailing Address - Fax:
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-246-8974
Practice Address - Fax:818-246-7673
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46741207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G467410Medicaid
CAG46741OtherMEDICAL BOARD
CARHD 130967OtherX-RAY SUPERVISOR & OPERAT
CARHD 130967OtherX-RAY SUPERVISOR & OPERAT
CAWG46741CMedicare ID - Type Unspecified
CARHD 130967OtherX-RAY SUPERVISOR & OPERAT