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NPI Code Detail

MEDICARE: WAYMAN D. MERRILL III MD

MEDICARE: WAYMAN D. MERRILL III MD
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
1207Q00000XFamily Medicine PhysicianG29834CA

General Provider Information

NPI Number : 1225186190
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYMAN D. MERRILL III MD
Provider Business Mailing Address
First Line : 4335 MARINA CITY DR UNIT 1144
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-5802
Country : US
Telephone Number : 310-291-4243
Fax Number :
Provider Business Practice Location Address
First Line : 111 N SEPULVEDA BLVD STE 210
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-6849
Country : US
Telephone Number : 310-379-2134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 12/20/2008

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