Provider Demographics
NPI:1144704800
Name:MERKLE, DAVID ROBERT (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:MERKLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 PALISADES PARK CT STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7131
Mailing Address - Country:US
Mailing Address - Phone:239-936-8555
Mailing Address - Fax:239-936-5611
Practice Address - Street 1:6821 PALISADES PARK CT STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7131
Practice Address - Country:US
Practice Address - Phone:239-936-8555
Practice Address - Fax:239-936-5611
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA91116042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9111604OtherLICENSE NUMBER