Basic Information
| Provider Information | |||||||||
| NPI: | 1073543062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERKOW | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 58TH AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806344807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704950300 | ||||||||
| FaxNumber: | 9702249624 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 58TH AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806344807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704950300 | ||||||||
| FaxNumber: | 9702249624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 43721 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | C810462 | 01 | CO | C802022 | OTHER | 16571843 | 05 | CO | MEDICAID |