MEDICARE: DR. MERRICK DAVID ELIAS D.O.

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	207N00000X	Dermatology Physician	OS 8762	FL
2	207N00000X	Dermatology Physician	229435	NY
3	207NP0225X	Pediatric Dermatology Physician	OS 8762	FL
4	207NP0225X	Pediatric Dermatology Physician	229435	NY
5	207NS0135X	Procedural Dermatology Physician	OS 8762	FL
6	207NS0135X	Procedural Dermatology Physician	229435	NY

General Provider Information

NPI Number	:	1932314960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERRICK DAVID ELIAS D.O.

Provider Business Mailing Address
First Line	:	4610 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:	954-771-0582
Fax Number	:	954-771-6465

Provider Business Practice Location Address
First Line	:	4610 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:	954-771-0582
Fax Number	:	954-771-6465

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

Provider Enumeration Date	:	05/12/2007
Last Update Date	:	03/20/2015

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