Provider Demographics
NPI:1639144702
Name:MERRILL, PHILEMON R JR (PA-C)
Entity Type:Individual
Prefix:
First Name:PHILEMON
Middle Name:R
Last Name:MERRILL
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 S POWER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9281
Mailing Address - Country:US
Mailing Address - Phone:480-988-1659
Mailing Address - Fax:480-988-1871
Practice Address - Street 1:7400 S POWER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9281
Practice Address - Country:US
Practice Address - Phone:480-988-1659
Practice Address - Fax:480-988-1871
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1876363AM0700X
UT270990-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00059274OtherRAILROAD MEDICARE
AZZ168388Medicare PIN
UT005734802Medicare PIN
UTS51826Medicare UPIN