Provider Demographics
NPI:1235123241
Name:MERRYMAN, JEFFREY MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARSHALL
Last Name:MERRYMAN
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 1:411 LAUREL ST
Mailing Address - Street 2:STE 3170
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3017
Mailing Address - Country:US
Mailing Address - Phone:515-283-0463
Mailing Address - Fax:515-283-0794
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:STE 3170
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-283-0463
Practice Address - Fax:515-283-0794
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33365207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1212902Medicaid
IA1212902Medicaid
IAI0634Medicare PIN