Provider Demographics
NPI:1467422444
Name:MERRILL, BERKELEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BERKELEY
Middle Name:
Last Name:MERRILL
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 1:6100 HARRIS PKWY STE 1240
Mailing Address - Street 2:PEASE BUILDING
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4101
Mailing Address - Country:US
Mailing Address - Phone:817-346-0075
Mailing Address - Fax:817-346-0097
Practice Address - Street 1:6100 HARRIS PKWY STE 1240
Practice Address - Street 2:PEASE BUILDING
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4101
Practice Address - Country:US
Practice Address - Phone:817-346-0075
Practice Address - Fax:817-346-0097
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1054207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097028703Medicaid
TX097028704Medicaid
TX097028703Medicaid
TX8226K7Medicare ID - Type Unspecified
TX8L27364Medicare PIN