MEDICARE: BUFFALO MEDICAL CENTER INC

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	207R00000X	Internal Medicine Physician	ME0039056	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FS0939050	OTHER	FL	CHAMPUS

General Provider Information

NPI Number	:	1477621175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUFFALO MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	508 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33603-3415
Country	:	US
Telephone Number	:	813-229-3522
Fax Number	:	813-225-3486

Provider Business Practice Location Address
First Line	:	508 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33603-3415
Country	:	US
Telephone Number	:	813-229-3522
Fax Number	:	813-225-3486

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. WALWIN DOWDA METZGER
Credential	:	M.D.
Telephone Number	:	813-229-3522

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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Directions to “BUFFALO MEDICAL CENTER INC ” Practice Location

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