Provider Demographics
NPI:1588657431
Name:MERRILL, RONALD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
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 1:400 HOSPITAL DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2489
Mailing Address - Country:US
Mailing Address - Phone:903-641-4895
Mailing Address - Fax:903-641-4894
Practice Address - Street 1:3124 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2435
Practice Address - Country:US
Practice Address - Phone:903-641-4270
Practice Address - Fax:903-872-5321
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111432401Medicaid
TX111432404Medicaid
TX8G9849OtherBLUE CROSS
TX8G9849OtherBLUE CROSS
TX111432401Medicaid
TX8G6659Medicare PIN
TX111432404Medicaid