Provider Demographics
NPI:1881698579
Name:MERRITT, DOROTHY F (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:F
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 GULF FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-4095
Mailing Address - Country:US
Mailing Address - Phone:409-655-2770
Mailing Address - Fax:844-234-6011
Practice Address - Street 1:6608 GULF FWY STE 100
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-4095
Practice Address - Country:US
Practice Address - Phone:409-655-2770
Practice Address - Fax:844-234-6011
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9878207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127993703Medicaid
TX127993703Medicaid
TXB24869Medicare UPIN
TX88Z450Medicare ID - Type Unspecified