Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME44775 | FL |
NPI | 1134104169 |
---|---|
Provider Name | Dr. Karl Walter Metz |
First Address | Fort Walton Beach, FL 32547-6707 |
Second Address | Fort Walton Beach, FL 32547-6707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 16/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043130300 | (05) | FL |
46197 | BCBSFL (01) | FL |
D54979 | (02) |