Healthcare Provider Details

I. General information

NPI: 1699773176
Provider Name (Legal Business Name): MARK JOSEPH METZGER SR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 LAKE WORTH RD SUITE 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 TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO-0002641
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO-0002641
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO-0002641
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO-0002641
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO-0002641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: