Provider Demographics
NPI:1184710642
Name:MERKEL, CLIFFORD D (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:D
Last Name:MERKEL
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:PO BOX 8520
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1740
Practice Address - Street 1:1901 WEST LUGONIA AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:REDLANDSS
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-557-1600
Practice Address - Fax:909-557-1740
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46740207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD42986Medicare UPIN
CA00G467400Medicare ID - Type Unspecified