Provider Demographics
NPI:1427046283
Name:METZGER, MARY A (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:METZGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16474
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-6474
Mailing Address - Country:US
Mailing Address - Phone:501-771-4370
Mailing Address - Fax:501-327-9722
Practice Address - Street 1:17 ROSAIRES WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9103
Practice Address - Country:US
Practice Address - Phone:501-766-7762
Practice Address - Fax:501-868-4470
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00292207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59476OtherBLUE CROSS BLUE SHIELD
ARP00193408OtherRAILROAD MEDICARE
ARP00193408OtherRAILROAD MEDICARE
AR59476OtherBLUE CROSS BLUE SHIELD
AR59476C548Medicare PIN