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General NPI Number Information
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NPI Number | 1689648719
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Entity Type | Individual
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Provider Name | THOMAS GORDON MERRY MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 1649 LUCERNE ST STE A & B
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City | MINDEN
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State | NV
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Zip | 89423-4369
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Country | US
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Telephone | 775-782-1603
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Fax | 775-782-3417
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Provider Business Mailing Address
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Address Line | 1520 VIRGINIA RANCH RD
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City | GARDNERVILLE
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State | NV
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Zip | 89410-5731
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Country | US
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Telephone | 775-782-1550
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Fax | 775-782-1513
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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 | 7634
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License Number State | NV
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