Provider Demographics
NPI:1184689119
Name:MERRITT, HENRY NEYRON JR (DPM)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:NEYRON
Last Name:MERRITT
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6630
Mailing Address - Country:US
Mailing Address - Phone:954-791-7474
Mailing Address - Fax:954-791-5807
Practice Address - Street 1:1160 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-6630
Practice Address - Country:US
Practice Address - Phone:954-791-7474
Practice Address - Fax:954-791-5807
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO385213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041159100Medicaid
T84628Medicare UPIN
FL87194Medicare ID - Type Unspecified