MEDICARE: DR. MARK JOSEPH METZGER SR. DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO-0002641	FL
2	213ER0200X	Radiology Podiatrist	PO-0002641	FL
3	213ES0000X	Sports Medicine Podiatrist	PO-0002641	FL
4	213ES0131X	Foot Surgery Podiatrist	PO-0002641	FL
5	246ZC0007X	Surgical Assistant
6	213ES0103X	Foot & Ankle Surgery Podiatrist	PO-0002641	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699773176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JOSEPH METZGER SR. DPM

Provider Business Mailing Address
First Line	:	3500 PRINCETON DR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-9353
Country	:	US
Telephone Number	:	561-939-6325
Fax Number	:	561-899-0460

Provider Business Practice Location Address
First Line	:	7138 LAKE WORTH RD
Second Line	:	SUITE C
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2970
Country	:	US
Telephone Number	:	561-939-6325
Fax Number	:	561-899-0460

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/26/2020

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