=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295806362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENT ALAN METTS MD,PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2006
-----------------------------------------------------
Last Update Date | 10/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7801 LAKEVIEW PKWY STE 120
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-4248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-475-9151
-----------------------------------------------------
Fax | 972-475-1757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7801 LAKEVIEW PKWY STE 120
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-4248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-329-8458
-----------------------------------------------------
Fax | 318-329-8460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | N3180
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | MD.205357
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 060935
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------