Healthcare Provider Details

I. General information

NPI: 1528166485
Provider Name (Legal Business Name): EVAN CHARD MERRILL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 E GALA CT STE 130
MERIDIAN ID
83642-2788
US

IV. Provider business mailing address

2667 E GALA CT STE 130
MERIDIAN ID
83642-2788
US

V. Phone/Fax

Practice location:
  • Phone: 208-855-5955
  • Fax: 208-459-8628
Mailing address:
  • Phone: 208-855-5955
  • Fax: 208-459-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9871345
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number9871345
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: