Provider Demographics
NPI:1326020207
Name:METCALF, NICHOLAS ANTHONY KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY KEVIN
Last Name:METCALF
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 1:5201 SUGAR MILL RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3874
Mailing Address - Country:US
Mailing Address - Phone:956-548-0485
Mailing Address - Fax:
Practice Address - Street 1:900 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-580-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1114207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139630119Medicaid
TX8R0692OtherBCBS
TX139630123Medicaid
TX8R0692OtherBCBS
TX139630119Medicaid
TX8D6303Medicare PIN
TXP00242405Medicare PIN