MEDICARE: DR. RODNEY W MERRELL M.D.

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	207Q00000X	Family Medicine Physician	168704-1205	UT

General Provider Information

NPI Number	:	1932196771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY W MERRELL M.D.

Provider Business Mailing Address
First Line	:	935 N 1000 W
Second Line	:
City	:	TREMONTON
State	:	UT
Zip	:	84337-9356
Country	:	US
Telephone Number	:	435-207-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 N 1000 W
Second Line	:
City	:	TREMONTON
State	:	UT
Zip	:	84337-9356
Country	:	US
Telephone Number	:	435-207-4800
Fax Number	:

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	03/01/2012

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