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General NPI Number Information
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NPI Number | 1588975361
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Entity Type | Individual
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Provider Name | LAURA MARIE MERRON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 3421 W 9TH ST SUITE 101
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City | WATERLOO
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State | IA
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Zip | 50702-5401
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Country | US
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Telephone | 319-272-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 BARTON AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5207
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Country | US
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Telephone | 319-464-5225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39682
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License Number State | IA
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