Provider Demographics
NPI:1639874753
Name:MERTEN, JOHN EDWARD
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:MERTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:EDWARD
Other - Last Name:MERTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3201 SPRINGHILL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2910
Mailing Address - Country:US
Mailing Address - Phone:501-945-8838
Mailing Address - Fax:
Practice Address - Street 1:3201 SPRINGHILL DR STE 400
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2910
Practice Address - Country:US
Practice Address - Phone:501-945-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program