Provider Demographics
NPI:1053394643
Name:MERRITT, WALTER D III (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:D
Last Name:MERRITT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8185 STATE HIGHWAY 789
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2942
Mailing Address - Country:US
Mailing Address - Phone:307-335-7555
Mailing Address - Fax:307-335-7999
Practice Address - Street 1:8185 STATE HIGHWAY 789
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2942
Practice Address - Country:US
Practice Address - Phone:307-335-7555
Practice Address - Fax:307-335-7999
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5753207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804259200Medicaid
ID804259200Medicaid
IDE62980Medicare UPIN