Provider Demographics
NPI:1932314960
Name:ELIAS, MERRICK DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:MERRICK
Middle Name:DAVID
Last Name:ELIAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5206
Mailing Address - Country:US
Mailing Address - Phone:954-771-0582
Mailing Address - Fax:954-771-6465
Practice Address - Street 1:4610 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5206
Practice Address - Country:US
Practice Address - Phone:954-771-0582
Practice Address - Fax:954-771-6465
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8762207N00000X, 207NP0225X, 207NS0135X
NY229435207N00000X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology