Healthcare Provider Details

I. General information

NPI: 1942405238
Provider Name (Legal Business Name): JASON DAVID MERRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/25/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86TH MDG, UNIT 3215, RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

86TH MDG, UNIT 3215, RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 210-787-6088
  • Fax:
Mailing address:
  • Phone: 210-787-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101245113
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101245113
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMEDS7779
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: