Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | K4152 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD2016-0750 | NM |
NPI | 1003819335 |
---|---|
Provider Name | Charles Lawrence Metzger |
First Address | Las Cruces, NM 88011-8259 |
Second Address | Las Cruces, NM 88011-8259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87921S | BLUE CROSS BLUE SHIELD (01) | TX |
F99676 | (02) | TX |