MEDICARE: CHARLES LAWRENCE METZGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	K4152	TX
2	207XS0106X	Orthopaedic Hand Surgery Physician	MD2016-0750	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87921S	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1003819335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LAWRENCE METZGER M.D.

Provider Business Mailing Address
First Line	:	4351 E LOHMAN AVE
Second Line	:	SUITE301
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8259
Country	:	US
Telephone Number	:	575-532-9755
Fax Number	:	575-532-8881

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE
Second Line	:	SUITE301
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8259
Country	:	US
Telephone Number	:	575-532-9755
Fax Number	:	575-532-8881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/31/2023

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