Provider Demographics
NPI:1912963943
Name:MERRILL, JARILYNNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JARILYNNE
Middle Name:B
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:#100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6094
Mailing Address - Country:US
Mailing Address - Phone:480-598-7500
Mailing Address - Fax:480-598-7510
Practice Address - Street 1:1151 N GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5127
Practice Address - Country:US
Practice Address - Phone:480-610-0688
Practice Address - Fax:480-969-6132
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ316412084P0800X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ829244Medicaid
AZH46931Medicare UPIN
AZ103134Medicare ID - Type Unspecified