Provider Demographics
NPI:1831144534
Name:MERKIN, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:MERKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2692 N GALLOWAY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-686-9339
Mailing Address - Fax:972-686-9799
Practice Address - Street 1:2692 N GALLOWAY
Practice Address - Street 2:SUITE 403
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-686-9339
Practice Address - Fax:972-686-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139078303Medicaid
TX00MA97Medicare PIN
C19316Medicare UPIN