Provider Demographics
NPI:1689620288
Name:MERKEL, ROBERT G (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:MERKEL
Suffix:
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 1:201 ALPHA WAY
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-1045
Mailing Address - Country:US
Mailing Address - Phone:509-674-5331
Mailing Address - Fax:509-674-5034
Practice Address - Street 1:201 ALPHA WAY
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1045
Practice Address - Country:US
Practice Address - Phone:509-674-5331
Practice Address - Fax:509-674-5034
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1004358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS94283Medicare UPIN
WA8855861Medicare ID - Type Unspecified