Basic Information
| Provider Information | |||||||||
| NPI: | 1669491031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DON | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 W DRY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840656768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019959933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 517 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024384692 | ||||||||
| FaxNumber: | 7024852372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5583587-1204 | UT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | PENDING | NV | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208D00000X | DO3051 | NV | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.