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NPI Code Detail

MEDICARE: ROBERT BENJAMIN MERRICK M.D.

MEDICARE: ROBERT BENJAMIN MERRICK 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
12085R0202XDiagnostic Radiology Physician21692IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
230055OTHERIABLUE CROSS BLUE SHIELD IA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346233590
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT BENJAMIN MERRICK M.D.
Provider Business Mailing Address
First Line : 250 MERCY DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-7320
Country : US
Telephone Number : 563-589-8796
Fax Number : 563-587-8776
Provider Business Practice Location Address
First Line : 250 MERCY DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-7320
Country : US
Telephone Number : 563-589-8796
Fax Number : 563-587-8776
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 12/11/2007

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