Provider Demographics
NPI:1114965381
Name:METZGER, ANDREW K (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:METZGER
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 1:2910 N 3RD AVE # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-3181
Mailing Address - Fax:602-264-2417
Practice Address - Street 1:3420 S MERCY RD STE 221
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0424
Practice Address - Country:US
Practice Address - Phone:480-681-7374
Practice Address - Fax:480-883-0514
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001257207T00000X
AZ70181207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN6965Medicaid
AZ132892Medicaid
NM341409801Medicare ID - Type Unspecified