Provider Demographics
NPI:1740265610
Name:MERRILL, BARRY S (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:MERRILL
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 1:1000 NW 9TH CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2268
Mailing Address - Country:US
Mailing Address - Phone:561-368-4444
Mailing Address - Fax:561-750-8368
Practice Address - Street 1:1000 NW 9TH CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2268
Practice Address - Country:US
Practice Address - Phone:561-368-4444
Practice Address - Fax:561-750-8368
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85562207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266629400Medicaid
290427Medicare ID - Type Unspecified
FL266629400Medicaid