Provider Demographics
NPI:1275067654
Name:MERRITT, GERALD IV (DPM)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:MERRITT
Suffix:IV
Gender:M
Credentials:DPM
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 9058
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-9058
Mailing Address - Country:US
Mailing Address - Phone:480-378-3388
Mailing Address - Fax:602-429-8432
Practice Address - Street 1:11851 N 51ST AVE STE E140
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2844
Practice Address - Country:US
Practice Address - Phone:480-378-3388
Practice Address - Fax:602-429-8432
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-001061213ES0103X
OK356213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery