Healthcare Provider Details

I. General information

NPI: 1679562474
Provider Name (Legal Business Name): ROBERT J MERRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAIN ST
GUTTENBERG IA
52052-9108
US

IV. Provider business mailing address

PO BOX 550
GUTTENBERG IA
52052-0550
US

V. Phone/Fax

Practice location:
  • Phone: 563-252-2141
  • Fax: 563-252-9013
Mailing address:
  • Phone: 563-252-2141
  • Fax: 563-252-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18168
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: