Provider Demographics
NPI:1386617124
Name:MERRITT, LEE D (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:D
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:HIEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 DIAMOND STREET
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040
Mailing Address - Country:US
Mailing Address - Phone:712-423-2311
Mailing Address - Fax:712-423-3500
Practice Address - Street 1:2051 W 25TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6911
Practice Address - Country:US
Practice Address - Phone:928-344-8220
Practice Address - Fax:928-726-0779
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD33430207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ321406Medicaid
AZZ200022292Medicare PIN
F54609Medicare UPIN
AZ321406Medicaid
AZ1064210001Medicare PIN