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General NPI Number Information
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NPI Number | 1801237276
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Entity Type | Individual
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Provider Name | JOHN MOORE MERRILL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 40515 COUNTY ROAD 69A SUITE B
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City | HAYDEN
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State | CO
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Zip | 81639-9504
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Country | US
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Telephone | 970-276-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 40515 COUNTY ROAD 69A SUITE B
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City | HAYDEN
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State | CO
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Zip | 81639-9504
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Country | US
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Telephone | 970-276-1933
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | DR 0038411
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License Number State | CO
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