Provider Demographics
NPI:1396728028
Name:MERKEL, EARL DEAN (MD)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:DEAN
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 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2920
Mailing Address - Country:US
Mailing Address - Phone:785-483-3131
Mailing Address - Fax:785-483-4859
Practice Address - Street 1:222 S KANSAS ST
Practice Address - Street 2:STE E
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-3000
Practice Address - Country:US
Practice Address - Phone:785-483-3333
Practice Address - Fax:785-483-4233
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-11253207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100085860EMedicaid
KS110498OtherBCBS GROUP
KS622440OtherST GUARD
KS103168OtherBCBS PERSONAL
KS100085860CMedicaid
KS622440Other!ST GUARD
KS110498Medicare ID - Type UnspecifiedGROUP
KS103168OtherBCBS PERSONAL
B68762Medicare UPIN