Provider Demographics
NPI:1699099978
Name:MERRILL, PETER COLE (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:COLE
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 W ORANGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3118
Mailing Address - Country:US
Mailing Address - Phone:520-575-0800
Mailing Address - Fax:520-575-0093
Practice Address - Street 1:2163 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3118
Practice Address - Country:US
Practice Address - Phone:520-575-0800
Practice Address - Fax:520-575-0093
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0705213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOP00857000OtherMEDICARE RR
AZ3Z4231OtherHEALTHNET
AZ1699099978OtherBCBS
AZ519694Medicaid
AZ138126Medicare PIN