MEDICARE: JASON A MERRICK 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
1	207Q00000X	Family Medicine Physician	E3015	AR

General Provider Information

NPI Number	:	1578524435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON A MERRICK MD

Provider Business Mailing Address
First Line	:	PO BOX 1325
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023
Country	:	US
Telephone Number	:	501-843-4555
Fax Number	:	501-843-7081

Provider Business Practice Location Address
First Line	:	2037 WEST MAIN
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023
Country	:	US
Telephone Number	:	501-843-4555
Fax Number	:	501-843-7081

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	07/08/2007

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