Provider Demographics
NPI:1346213741
Name:METZGER, LORETTA J (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:J
Last Name:METZGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5885
Mailing Address - Country:US
Mailing Address - Phone:702-779-3252
Mailing Address - Fax:702-779-3253
Practice Address - Street 1:1701 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 4A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-779-3252
Practice Address - Fax:702-779-3253
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018062Medicaid
NV36192Medicare ID - Type Unspecified
NV2018062Medicaid