Healthcare Provider Details

I. General information

NPI: 1538324892
Provider Name (Legal Business Name): MORGAN F MERRILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOSPITAL DR STE 200
SEDRO WOOLLEY WA
98284-9315
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-8004
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-8810
  • Fax: 360-714-2520
Mailing address:
  • Phone: 360-729-1462
  • Fax: 360-729-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8105
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEP5798
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60555205
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: