Healthcare Provider Details

I. General information

NPI: 1538748991
Provider Name (Legal Business Name): M. J. METZGER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 LAKE WORTH RD STE C
LAKE WORTH FL
33467-2970
US

IV. Provider business mailing address

3500 PRINCETON DR
WELLINGTON FL
33414-9353
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-6325
  • Fax: 561-899-0460
Mailing address:
  • Phone: 561-939-6325
  • Fax: 561-899-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK JOSEPH METZGER SR.
Title or Position: PHYSICIAN
Credential: DPM
Phone: 561-939-6325