Healthcare Provider Details

I. General information

NPI: 1275067654
Provider Name (Legal Business Name): GERALD MERRITT IV DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18301 N 79TH AVE
GLENDALE AZ
85308-8463
US

IV. Provider business mailing address

18301 N 79TH AVE
GLENDALE AZ
85308-8463
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-9090
  • Fax:
Mailing address:
  • Phone: 623-544-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-001153
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: