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General NPI Number Information
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NPI Number | 1982648929
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Entity Type | Individual
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Provider Name | BRIAN LONGHURST MERRILL DO
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 100 POLK COUNTY PLZ STE 180
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City | BALSAM LAKE
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State | WI
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Zip | 54810-8009
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Country | US
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Telephone | 715-485-8876
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 N 500 E SUITE 330
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City | LOGAN
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State | UT
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Zip | 84341-2408
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Country | US
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Telephone | 435-716-5790
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Fax | 435-716-2921
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 73041
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4993153
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1851-321
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License Number State | WI
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