Healthcare Provider Details

I. General information

NPI: 1245350164
Provider Name (Legal Business Name): IAN MERRILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N 115TH ST STE 320
SEATTLE WA
98133-8400
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-4744
  • Fax: 206-215-1135
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD 00047983
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: