Provider Demographics
NPI:1962466128
Name:HART, MERRY BETH (MD)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:BETH
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-785-8685
Practice Address - Street 1:416 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4162
Practice Address - Country:US
Practice Address - Phone:806-761-0536
Practice Address - Fax:806-761-0537
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8723208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141143101Medicaid
TX141143101Medicaid
TX8C5830Medicare ID - Type Unspecified