Provider Demographics
NPI:1194780445
Name:CONANT, MERRILL R (MD)
Entity type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:R
Last Name:CONANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W ROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2131
Mailing Address - Country:US
Mailing Address - Phone:620-225-1650
Mailing Address - Fax:620-227-2505
Practice Address - Street 1:120 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2131
Practice Address - Country:US
Practice Address - Phone:620-225-1650
Practice Address - Fax:620-227-2505
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420546207Q00000X
KSAC2832738207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100157800FMedicaid
KS1001157800BMedicaid
KS100535OtherBCBS
B91221Medicare UPIN
KS100535Medicare ID - Type Unspecified
KS100535OtherBCBS