Provider Demographics
NPI:1790742468
Name:BARRON, MERRILL R (MD)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:R
Last Name:BARRON
Suffix:
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 1:4585 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1880
Mailing Address - Country:US
Mailing Address - Phone:334-340-2600
Mailing Address - Fax:334-340-2620
Practice Address - Street 1:4585 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1880
Practice Address - Country:US
Practice Address - Phone:334-340-2600
Practice Address - Fax:334-340-2620
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000097713Medicaid
AL000097713Medicare PIN
ALC71973Medicare UPIN
ALH738Medicare PIN