Provider Demographics
NPI:1619933942
Name:MERRITT, BROCK ADAM (DO)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:ADAM
Last Name:MERRITT
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 1:727 E BETHANY HOME RD
Mailing Address - Street 2:STE B112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2151
Mailing Address - Country:US
Mailing Address - Phone:602-973-3100
Mailing Address - Fax:602-973-0978
Practice Address - Street 1:7550 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7980
Practice Address - Country:US
Practice Address - Phone:602-973-3100
Practice Address - Fax:602-973-0978
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ866098Medicaid
AZ83936Medicare PIN
AZ866098Medicaid