Healthcare Provider Details

I. General information

NPI: 1083696074
Provider Name (Legal Business Name): PHILIP ORMOND MERRITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER SUITE 200
GLENDALE CA
91206-4071
US

IV. Provider business mailing address

1357 SUGAR LOAF DR
LA CANADA CA
91011-3919
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-8974
  • Fax: 818-246-7673
Mailing address:
  • Phone: 818-790-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG46741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: