Provider Demographics
NPI:1134111545
Name:MERRILL, ANINA (MD)
Entity Type:Individual
Prefix:
First Name:ANINA
Middle Name:
Last Name:MERRILL
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 1:8074 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0743
Mailing Address - Country:US
Mailing Address - Phone:801-565-6500
Mailing Address - Fax:801-565-6774
Practice Address - Street 1:8074 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-0743
Practice Address - Country:US
Practice Address - Phone:801-565-6500
Practice Address - Fax:801-565-6774
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333392-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011869Medicare PIN