Basic Information
| Provider Information | |||||||||
| NPI: | 1538324892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291462 | ||||||||
| FaxNumber: | 3607293104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1990 HOSPITAL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SEDRO WOOLLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982849315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608568810 | ||||||||
| FaxNumber: | 3607142520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 10/26/2018 | ||||||||
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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 | 8105 | SD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TEP5798 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60555205 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 47055301100 | 05 | NE | MEDICAID |