Healthcare Provider Details

I. General information

NPI: 1720064058
Provider Name (Legal Business Name): JONATHAN C. MERKLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SALEM RD SUITE 1
MONTEVALLO AL
35115-3586
US

IV. Provider business mailing address

33 SALEM RD SUITE 1
MONTEVALLO AL
35115-3586
US

V. Phone/Fax

Practice location:
  • Phone: 205-665-7991
  • Fax: 205-665-2913
Mailing address:
  • Phone: 205-665-7991
  • Fax: 205-665-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21192
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: