Provider Demographics
NPI:1265591697
Name:MERRILL, RODNEY STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:STEPHEN
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:434 E 5350 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5418
Mailing Address - Country:US
Mailing Address - Phone:801-479-1641
Mailing Address - Fax:801-476-8538
Practice Address - Street 1:434 E 5350 S
Practice Address - Street 2:SUITE A
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5418
Practice Address - Country:US
Practice Address - Phone:801-479-1641
Practice Address - Fax:801-476-8538
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2016-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3708201204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012153Medicare PIN
F86490Medicare UPIN