Provider Demographics
NPI:1639514706
Name:MERCKLE, BENJAMIN GAVIN (CSFA)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:GAVIN
Last Name:MERCKLE
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6639
Mailing Address - Country:US
Mailing Address - Phone:850-863-2153
Mailing Address - Fax:
Practice Address - Street 1:1034 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6639
Practice Address - Country:US
Practice Address - Phone:850-863-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant