Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN 17555 | FL |
NPI | 1063443505 |
---|---|
Provider Name | Dr. John Jeffrey Metz |
First Address | Land O Lakes, FL 34638-4317 |
Second Address | Land O Lakes, FL 34638-4317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 09/06/2009 |