Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | PO-0002641 | FL |
N | 111NR0200X | Radiology | PO-0002641 | FL |
N | 213ER0200X | Radiology | PO-0002641 | FL |
N | 2081S0010X | Sports Medicine | PO-0002641 | FL |
N | 213ES0000X | Sports Medicine | PO-0002641 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO-0002641 | FL |
N | 213ES0131X | Foot Surgery | PO-0002641 | FL |
NPI | 1699773176 |
---|---|
Provider Name | Dr. Mark Joseph Metzger SR. |
First Address | Wellington, FL 33414-9353 |
Second Address | Lake Worth, FL 33467-2970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340097200 | (05) | FL |
U72908 | (02) | FL |