Basic Information
| Provider Information | |||||||||
| NPI: | 1396728028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERKEL | ||||||||
| FirstName: | EARL | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RUSSELL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676652920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854833131 | ||||||||
| FaxNumber: | 7854834859 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 S KANSAS ST | ||||||||
| Address2: | STE E | ||||||||
| City: | RUSSELL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676653000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854833333 | ||||||||
| FaxNumber: | 7854834233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 04-11253 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208600000X | 04-11253 | KS | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100085860E | 05 | KS | MEDICAID | 110498 | 01 | KS | BCBS GROUP | OTHER | 622440 | 01 | KS | ST GUARD | OTHER | 103168 | 01 | KS | BCBS PERSONAL | OTHER | 100085860C | 05 | KS | MEDICAID |