Provider Demographics
NPI:1114009859
Name:MERRILL, JAMES ERWIN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERWIN
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-776-5982
Mailing Address - Fax:906-774-4735
Practice Address - Street 1:1001 S HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3805
Practice Address - Country:US
Practice Address - Phone:906-776-5982
Practice Address - Fax:904-774-4735
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011179207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00608850OtherRR MEDICARE
WI30062500Medicaid
MI5183431Medicaid
MI1652201024OtherBCBS MI
MI5183431Medicaid
MI1652201024OtherBCBS MI