MEDICARE: DR. CLINTON FRANKLIN MERRILL JR. 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	207RH0003X	Hematology & Oncology Physician	3277A	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	W27189	OTHER	WY	MEDICARE PTAN (WY)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3277A	OTHER	WY	WYOMING MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	311538	OTHER	WY	BCBS

General Provider Information

NPI Number	:	1992707285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINTON FRANKLIN MERRILL JR. M.D.

Provider Business Mailing Address
First Line	:	15 SHRINE CLUB RD
Second Line	:
City	:	LANDER
State	:	WY
Zip	:	82520-8501
Country	:	US
Telephone Number	:	307-332-0324
Fax Number	:	307-332-0382

Provider Business Practice Location Address
First Line	:	15 SHRINE CLUB RD
Second Line	:
City	:	LANDER
State	:	WY
Zip	:	82520-8501
Country	:	US
Telephone Number	:	307-332-0324
Fax Number	:	307-332-0382

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/09/2016

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Directions to “ DR. CLINTON FRANKLIN MERRILL JR. M.D.” Practice Location

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