Provider Demographics
NPI:1902420300
Name:MERRILL, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MERRILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 N FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-6006
Mailing Address - Country:US
Mailing Address - Phone:801-244-7459
Mailing Address - Fax:
Practice Address - Street 1:201 VANDENBERG DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-6103
Practice Address - Country:US
Practice Address - Phone:801-244-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife