Provider Demographics
NPI:1023051349
Name:MERKLE, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MERKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 N NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6716
Mailing Address - Country:US
Mailing Address - Phone:314-567-1656
Mailing Address - Fax:314-567-0622
Practice Address - Street 1:774 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6716
Practice Address - Country:US
Practice Address - Phone:314-567-1656
Practice Address - Fax:314-567-0622
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
183229OtherHEALTHLINK
1601253OtherUHC
1601058OtherUHC
MO202788410Medicaid
1015722OtherCARE PRT
202788410OtherHEALTHCARE USA