MEDICARE: DR. PHILIP ORMOND MERRITT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	G46741	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G46741	OTHER	CA	MEDICAL BOARD
3	RHD 130967	OTHER	CA	X-RAY SUPERVISOR & OPERAT

General Provider Information

NPI Number	:	1083696074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ORMOND MERRITT M.D.

Provider Business Mailing Address
First Line	:	1357 SUGAR LOAF DR
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-3919
Country	:	US
Telephone Number	:	818-790-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 WILSON TER
Second Line	:	SUITE 200
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-246-8974
Fax Number	:	818-246-7673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/07/2023

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