Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00032752 | WA |
NPI | 1023033487 |
---|---|
Provider Name | Michael Scott Metzman |
First Address | Silverdale, WA 98383-2347 |
Second Address | Silverdale, WA 98383-8309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 28/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070008547 | RAILROAD (01) | WA |
8188062 | (05) | WA |
F64862 | (02) | WA |