Basic Information
| Provider Information | |||||||||
| NPI: | 1013009604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERKEL | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 E HARMONY RD | ||||||||
| Address2: | STE 370 | ||||||||
| City: | FT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702212290 | ||||||||
| FaxNumber: | 9702950036 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 E HARMONY RD | ||||||||
| Address2: | STE 370 | ||||||||
| City: | FT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702212290 | ||||||||
| FaxNumber: | 9702950036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 19158 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01191584 | 05 | CO | MEDICAID |