Healthcare Provider Details

I. General information

NPI: 1720017254
Provider Name (Legal Business Name): JEFFREY D MERRILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST NEONATOLOGY - 3RD FLOOR
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST NEONATOLOGY - 3RD FLOOR
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-5282
  • Fax: 510-450-5823
Mailing address:
  • Phone: 510-428-5282
  • Fax: 510-450-5823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA46081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: