Provider Demographics
NPI:1023033487
Name:METZMAN, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:METZMAN
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:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-2347
Mailing Address - Country:US
Mailing Address - Phone:360-692-7318
Mailing Address - Fax:360-308-0758
Practice Address - Street 1:9951 MICKELBERRY RD NW
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8309
Practice Address - Country:US
Practice Address - Phone:360-692-7318
Practice Address - Fax:360-308-0758
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032752207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8188062Medicaid
WA070008547OtherRAILROAD
WAF64862Medicare UPIN
WA070008547OtherRAILROAD