Provider Demographics
NPI:1861489379
Name:MERRELL, RAYMOND WELDON (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WELDON
Last Name:MERRELL
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 1:2500 RACQUET LN
Mailing Address - Street 2:STE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-249-3900
Mailing Address - Fax:509-573-9539
Practice Address - Street 1:2500 RACQUET LN
Practice Address - Street 2:STE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6114
Practice Address - Country:US
Practice Address - Phone:509-249-3900
Practice Address - Fax:509-573-9539
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025209MD00018258208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA340010369OtherRAILROAD MEDICARE PIN
WA1881408Medicaid
WA340011806OtherRAILROAD MEDICARE PIN
WAGAB20548Medicare PIN
WAG115145904Medicare PIN
WAA06579Medicare UPIN