Provider Demographics
NPI:1801237276
Name:MERRILL, JOHN MOORE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MOORE
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 1:40515 COUNTY ROAD 69A
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAYDEN
Mailing Address - State:CO
Mailing Address - Zip Code:81639-9504
Mailing Address - Country:US
Mailing Address - Phone:970-276-1933
Mailing Address - Fax:
Practice Address - Street 1:40515 COUNTY ROAD 69A
Practice Address - Street 2:SUITE B
Practice Address - City:HAYDEN
Practice Address - State:CO
Practice Address - Zip Code:81639-9504
Practice Address - Country:US
Practice Address - Phone:970-276-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR 0038411207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology