Provider Demographics
NPI:1639264708
Name:MERRITT, PAMELA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N MARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6611
Mailing Address - Country:US
Mailing Address - Phone:323-436-5000
Mailing Address - Fax:
Practice Address - Street 1:6405 N FEDERAL HWY STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1414
Practice Address - Country:US
Practice Address - Phone:954-772-2411
Practice Address - Fax:954-772-3766
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265701500Medicaid
FLH64269Medicare UPIN