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Organization
MARK E. MERRIMAN, MD, A MEDICAL CORPORATION
Active
Organization
MARK E. MERRIMAN, MD, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK E. MERRIMAN M.D. (PRESIDENT)
(209) 473-6555
Entity
Organization
Contact information
Practice address
20750 VENTURA BLVD SUITE 210, WOODLAND HILLS, CA 91364-6235
(818) 888-7815
(818) 715-7122
Mailing address
PO BOX 7001, TARZANA, CA 91357-7001
(818) 888-7815
(818) 715-1722
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G71754
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG825A
MEDICARE PTAN
—
Enumeration date
08/05/2006
Last updated
08/07/2019
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