Basic Information
| Provider Information | |||||||||
| NPI: | 1437172459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRITT | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | C B 8064 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142734724 | ||||||||
| FaxNumber: | 3147471481 | ||||||||
| Practice Location | |||||||||
| Address1: | 4901 FOREST PARK AVE STE 710 | ||||||||
| Address2: | STE 710 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631081402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142734724 | ||||||||
| FaxNumber: | 3147471481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | R7459 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200729317 | 05 | MO | MEDICAID | 0351975109 | 05 | IL | MEDICAID |