Provider Demographics
NPI:1770763500
Name:MERRITT, MARK W (RDMS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:MERRITT
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 NW RITCHIE ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3115
Mailing Address - Country:US
Mailing Address - Phone:509-995-3329
Mailing Address - Fax:
Practice Address - Street 1:945 NW RITCHIE ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3115
Practice Address - Country:US
Practice Address - Phone:509-995-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
109842471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography