=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952671653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. HENRY N MERRITT JR PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2012
-----------------------------------------------------
Last Update Date | 01/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1160 N STATE ROAD 7
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33313-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-791-7474
-----------------------------------------------------
Fax | 954-791-5807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 N STATE ROAD 7
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33313-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-791-7474
-----------------------------------------------------
Fax | 954-791-5807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HENRY N MERRITT JR.
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 954-791-7474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO385
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------