MEDICARE: DR. GEORGE ROBERT MERRIMAN II 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	208600000X	Surgery Physician	09092R	LA

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

General Provider Information

NPI Number	:	1285670356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ROBERT MERRIMAN II M.D.

Provider Business Mailing Address
First Line	:	949 OLIVE ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2103
Country	:	US
Telephone Number	:	318-222-3132
Fax Number	:	318-222-3865

Provider Business Practice Location Address
First Line	:	949 OLIVE ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2103
Country	:	US
Telephone Number	:	318-222-3132
Fax Number	:	318-222-3865

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	02/19/2020

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