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General NPI Number Information
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NPI Number | 1639144702
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Entity Type | Individual
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Provider Name | PHILEMON R MERRILL JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 7400 S POWER RD SUITE 120
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City | GILBERT
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State | AZ
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Zip | 85297-9281
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Country | US
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Telephone | 480-988-1659
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Fax | 480-988-1871
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Provider Business Mailing Address
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Address Line | 7400 S POWER RD SUITE 120
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City | GILBERT
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State | AZ
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Zip | 85297-9281
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Country | US
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Telephone | 480-988-1659
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Fax | 480-988-1871
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1876
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 270990-1206
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License Number State | UT
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