Provider Demographics
NPI:1720064058
Name:MERKLE, JONATHAN C (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:MERKLE
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 1:33 SALEM RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-3586
Mailing Address - Country:US
Mailing Address - Phone:205-665-7991
Mailing Address - Fax:205-665-2913
Practice Address - Street 1:33 SALEM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-3586
Practice Address - Country:US
Practice Address - Phone:205-665-7991
Practice Address - Fax:205-665-2913
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51507997OtherBLUE CROSS/BLUE SHIELD AL
ALG96107Medicare UPIN