Individual
CLYDE EDWARD MERRILL
Active
Individual
CLYDE EDWARD MERRILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
01203
WV
363AS0400X
Surgical Physician Assistant
50.002444
OH
363AS0400X
Surgical Physician Assistant
Primary
5415
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000635240
ANTHEM
OH
01
—
000000723364
ANTHEM
OH
05
—
0070594
—
OH
01
—
01203
WV LICENSE
WV
Enumeration date
07/28/2008
Last updated
03/06/2015
Update your record
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