Provider Demographics
NPI:1427272590
Name:ZUMWALT, MERLE LAWRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:MERLE
Middle Name:LAWRENCE
Last Name:ZUMWALT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7339 INDIAN MOUND TRAIL
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:IN
Mailing Address - Zip Code:47920-9720
Mailing Address - Country:US
Mailing Address - Phone:765-567-4642
Mailing Address - Fax:574-722-1274
Practice Address - Street 1:729 HIGH ST
Practice Address - Street 2:LOGANSPORT JUVENILE FACILITY
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947
Practice Address - Country:US
Practice Address - Phone:574-753-5549
Practice Address - Fax:574-722-1274
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01033621B208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24677Medicare UPIN