Healthcare Provider Details

I. General information

NPI: 1336300169
Provider Name (Legal Business Name): HALLIE A METZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 OLD PECOS TRL SUITE H
SANTA FE NM
87505-4776
US

IV. Provider business mailing address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-0233
  • Fax: 505-992-0609
Mailing address:
  • Phone: 831-624-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2009-0154
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: