Provider Demographics
NPI:1821022492
Name:MERRITT, TAMARA ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ELLEN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1316
Mailing Address - Country:US
Mailing Address - Phone:509-548-3430
Mailing Address - Fax:509-548-2510
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:509-548-5815
Practice Address - Fax:509-548-2510
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002089207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA316507OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA8464240Medicaid
WA452251OtherDEPARTMENT OF LABOR AND INDUSTRIES