MEDICARE: CAROLYN RHENE MERKOURIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G71953	CA
2	208M00000X	Hospitalist Physician	G71953	CA
3	174400000X	Specialist	4440	AK

General Provider Information

NPI Number	:	1174503395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN RHENE MERKOURIS MD

Provider Business Mailing Address
First Line	:	1321 COTTONWOOD ST FL 3
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-5131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 COTTONWOOD ST FL 3
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-5131
Country	:	US
Telephone Number	:	530-668-2600
Fax Number	:	530-661-2410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	04/22/2026

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