Provider Demographics
NPI:1689648719
Name:MERRY, THOMAS GORDON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GORDON
Last Name:MERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 VIRGINIA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5731
Mailing Address - Country:US
Mailing Address - Phone:775-782-1550
Mailing Address - Fax:775-782-1513
Practice Address - Street 1:1649 LUCERNE ST
Practice Address - Street 2:STE A & B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4369
Practice Address - Country:US
Practice Address - Phone:775-782-1603
Practice Address - Fax:775-782-3417
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV7634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002003030Medicaid
NV003103030Medicaid
NV002003030Medicaid
NVV36235Medicare PIN