Individual
MR. SHANE MERCHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
410 W 16TH AVE, TYNDALL, SD 57066-2318
(605) 589-2188
(605) 589-4603
Mailing address
410 W 16TH AVE, TYNDALL, SD 57066-2318
(605) 589-2188
(605) 589-4603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0887
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2007146
—
SD
Enumeration date
09/30/2013
Last updated
08/25/2020
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