Provider Demographics
NPI:1275067654
Name:MERRITT, GERALD IV (DPM)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:MERRITT
Suffix:IV
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MEDICAL PLAZA DR STE 180
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3250
Mailing Address - Country:US
Mailing Address - Phone:281-364-9041
Mailing Address - Fax:
Practice Address - Street 1:1120 MEDICAL PLAZA DR STE 180
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3250
Practice Address - Country:US
Practice Address - Phone:281-364-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-001061213ES0103X
OK356213ES0103X
TX3071208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery