Provider Demographics
NPI:1518960392
Name:MERCHANT, THOMAS E (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PLACE MS 0515
Mailing Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL # MS 0515
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN011352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100345630BMedicaid
MO245028600Medicaid
MS00118062Medicaid
KY64926934Medicaid
IA0529107Medicaid
IN200179760AMedicaid
ME422400000Medicaid
AL009914390Medicaid
NE100249681-00Medicaid
LA1534714Medicaid
MI114670490Medicaid
OH2007616Medicaid
GA113856909AMedicaid
TN3304767Medicaid
NC7612399Medicaid
NY01365315-03Medicaid
AZ565955Medicaid
AL009914390Medicaid
IA0529107Medicaid