Provider Demographics
NPI:1669491031
Name:MERRILL, ROBERT DON (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DON
Last Name:MERRILL
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 1:2615 W DRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6768
Mailing Address - Country:US
Mailing Address - Phone:801-995-9933
Mailing Address - Fax:
Practice Address - Street 1:517 ROSE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4020
Practice Address - Country:US
Practice Address - Phone:702-438-4692
Practice Address - Fax:702-485-2372
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5583587-1204207V00000X
NVPENDING207V00000X
NVDO3051208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870280457003Medicaid
UT870280457003Medicaid
UT007044007Medicare ID - Type Unspecified