Provider Demographics
NPI:1124006598
Name:MERRITT, THURMAN ALLEN
Entity Type:Individual
Prefix:DR
First Name:THURMAN
Middle Name:ALLEN
Last Name:MERRITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 5TH ST UNIT C1020
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9599
Mailing Address - Country:US
Mailing Address - Phone:541-451-7820
Mailing Address - Fax:541-451-7236
Practice Address - Street 1:701 N 5TH ST UNIT C1020
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9599
Practice Address - Country:US
Practice Address - Phone:541-451-7820
Practice Address - Fax:541-451-7236
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD198632080N0001X
CAG282942080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080635Medicaid
D79131Medicare UPIN