Provider Demographics
NPI:1669522827
Name:MERKELEY, WARD (MD)
Entity type:Individual
Prefix:
First Name:WARD
Middle Name:
Last Name:MERKELEY
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 1:910 N WASHINGTON ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2202
Mailing Address - Country:US
Mailing Address - Phone:509-232-1173
Mailing Address - Fax:509-232-1165
Practice Address - Street 1:1015 E 'D' STREET
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-0742
Practice Address - Country:US
Practice Address - Phone:509-276-5061
Practice Address - Fax:509-276-8713
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAM1108114207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8124504Medicaid
WA7086051Medicaid
WAGAB02213OtherMEDICARE GROUP
WAG000362000OtherMEDICARE GROUP
WA8124505Medicaid
WAG8868992Medicare PIN
WAE17791WMedicare UPIN
WA8124505Medicaid