Provider Demographics
NPI:1134104169
Name:METZ, KARL WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:WALTER
Last Name:METZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:LABORATORY
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8109
Mailing Address - Fax:850-862-5989
Practice Address - Street 1:1005 MAR WALT DR
Practice Address - Street 2:LABORATORY
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8109
Practice Address - Fax:850-862-5989
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44775207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043130300Medicaid
FL46197OtherBCBSFL
FL46197ZMedicare PIN
FL043130300Medicaid