Healthcare Provider Details

I. General information

NPI: 1689648719
Provider Name (Legal Business Name): THOMAS GORDON MERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 LUCERNE ST STE A & B
MINDEN NV
89423-4369
US

IV. Provider business mailing address

1520 VIRGINIA RANCH RD
GARDNERVILLE NV
89410-5731
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-1603
  • Fax: 775-782-3417
Mailing address:
  • Phone: 775-782-1550
  • Fax: 775-782-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7634
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: