Provider Demographics
NPI:1982648929
Name:MERRILL, BRIAN LONGHURST (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LONGHURST
Last Name:MERRILL
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 1:1300 N 500 E
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2408
Mailing Address - Country:US
Mailing Address - Phone:435-716-5790
Mailing Address - Fax:435-716-2921
Practice Address - Street 1:100 POLK COUNTY PLZ STE 180
Practice Address - Street 2:
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-8009
Practice Address - Country:US
Practice Address - Phone:715-485-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN730412084P0800X
UT49931532084P0800X
WI1851-3212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT751650OtherDMBA
UT200521603BM2OtherEMIA
UT79126OtherPEHP
UT200521603OtherFIRSTHEALTH
UT49931531200001OtherBCBS OF UT
UT107012431102OtherSELECTHEALTH
UT79126OtherPEHP
UT751650OtherDMBA