Healthcare Provider Details

I. General information

NPI: 1770763500
Provider Name (Legal Business Name): MARK W MERRITT RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 NW RITCHIE ST
PULLMAN WA
99163-3115
US

IV. Provider business mailing address

945 NW RITCHIE ST
PULLMAN WA
99163-3115
US

V. Phone/Fax

Practice location:
  • Phone: 509-995-3329
  • Fax:
Mailing address:
  • Phone: 509-995-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number10984
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: