Healthcare Provider Details

I. General information

NPI: 1295900165
Provider Name (Legal Business Name): MONTE G. MERRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 620
PHOENIX AZ
85006-2850
US

IV. Provider business mailing address

1300 N 12TH ST STE 620
PHOENIX AZ
85006-2850
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-3668
  • Fax: 833-471-4328
Mailing address:
  • Phone: 602-283-3668
  • Fax: 833-471-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number58018
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number107866
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: