Provider Demographics
NPI:1437172459
Name:MERRITT, DIANE F (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:F
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8064
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-273-4724
Mailing Address - Fax:314-747-1481
Practice Address - Street 1:4901 FOREST PARK AVE STE 710
Practice Address - Street 2:STE 710
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1402
Practice Address - Country:US
Practice Address - Phone:314-273-4724
Practice Address - Fax:314-747-1481
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
MOR7459207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200729317Medicaid
IL0351975109Medicaid
IL0351975109Medicaid
MO160024118Medicare PIN