Healthcare Provider Details

I. General information

NPI: 1134730047
Provider Name (Legal Business Name): TERRY ALAN METZGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 10TH ST
DALLAS TX
75208-4523
US

IV. Provider business mailing address

210 W 10TH ST
DALLAS TX
75208-4523
US

V. Phone/Fax

Practice location:
  • Phone: 214-351-3490
  • Fax:
Mailing address:
  • Phone: 214-351-3490
  • Fax: 888-516-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: