Provider Demographics
NPI:1063430171
Name:METZINGER, DANIEL STEWART (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:STEWART
Last Name:METZINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST ACB/2ND FLOOR
Mailing Address - Street 2:DEPT OB/GYN ATT VICKI MASTERSON
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 S JACKSON ST
Practice Address - Street 2:BROWN CANCER CENTER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-561-7220
Practice Address - Fax:502-561-7327
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31317207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000007338ZOtherHUMANA PSC
000021037NOtherHUMANA FOUNDATION
KY64034218Medicaid
IN200336380Medicaid
KY64034218Medicaid
0060392Medicare PIN
IN200336380Medicaid
1275759Medicare PIN