Healthcare Provider Details

I. General information

NPI: 1669491031
Provider Name (Legal Business Name): ROBERT DON MERRILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 ROSE ST
LAS VEGAS NV
89106-4020
US

IV. Provider business mailing address

2615 W DRY CREEK DR
RIVERTON UT
84065-6768
US

V. Phone/Fax

Practice location:
  • Phone: 702-438-4692
  • Fax: 702-485-2372
Mailing address:
  • Phone: 801-995-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5583587-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberPENDING
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO3051
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: