Healthcare Provider Details

I. General information

NPI: 1225004286
Provider Name (Legal Business Name): GLENN R MERRITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 E MAPLEWOOD AVE STE 120
GREENWOOD VILLAGE CO
80111-4766
US

IV. Provider business mailing address

PO BOX 840862
DALLAS TX
75284-0862
US

V. Phone/Fax

Practice location:
  • Phone: 303-438-3999
  • Fax: 720-439-9500
Mailing address:
  • Phone: 303-377-7638
  • Fax: 303-780-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberDR.0026904
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0026904
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: