Provider Demographics
NPI:1972708592
Name:MERRILL, NANCY BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:BRADLEY
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6741 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3729
Mailing Address - Country:US
Mailing Address - Phone:817-370-1221
Mailing Address - Fax:214-768-2151
Practice Address - Street 1:SMU MEMORIAL STUDENT HEALTH CENTER
Practice Address - Street 2:6211 BISHOP BLVD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75275-0195
Practice Address - Country:US
Practice Address - Phone:214-768-2141
Practice Address - Fax:214-768-2151
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3552208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice