Provider Demographics
NPI:1770666018
Name:MERRIFIELD, DAVID L JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MERRIFIELD
Suffix:JR
Gender:M
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:PO BOX 5789
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5789
Mailing Address - Country:US
Mailing Address - Phone:423-915-1126
Mailing Address - Fax:423-915-0635
Practice Address - Street 1:401 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2028
Practice Address - Country:US
Practice Address - Phone:423-854-5880
Practice Address - Fax:423-854-5685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26618207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100143500Medicaid
TN1510289Medicaid
TN3818081Medicaid
TN3818081Medicare ID - Type Unspecified
TN10393I8420Medicare PIN
TN3818081Medicaid