Provider Demographics
NPI:1699773176
Name:METZGER, MARK JOSEPH SR (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:METZGER
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9353
Mailing Address - Country:US
Mailing Address - Phone:561-939-6325
Mailing Address - Fax:561-899-0460
Practice Address - Street 1:7138 LAKE WORTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2970
Practice Address - Country:US
Practice Address - Phone:561-939-6325
Practice Address - Fax:561-899-0460
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-0002641213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X, 213ES0103X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340097200Medicaid
FL65547YMedicare ID - Type UnspecifiedPAINCARE MEDICARE NUMBER
FL65547ZMedicare ID - Type Unspecified
FLU72908Medicare UPIN