Provider Demographics
NPI:1578505251
Name:MERRYWEATHER, JOHN FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:MERRYWEATHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 MONTE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3230
Mailing Address - Country:US
Mailing Address - Phone:801-272-0394
Mailing Address - Fax:801-272-0118
Practice Address - Street 1:2290 E 4500 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4492
Practice Address - Country:US
Practice Address - Phone:801-272-0394
Practice Address - Fax:801-272-0118
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109246-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT53133OtherUNI BEHAVIORAL HEALTH
UT7646OtherPUBLIC EMPLOYEES HEALTH
UT870439211ME2OtherEDUCATORS MUTUAL INSURANC
UT10700934101OtherINTERMOUNTAIN HEALTH CARE