Provider Demographics
NPI:1366441347
Name:METNICK, ROBERT F (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:METNICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 APPALOOSA RD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-9060
Mailing Address - Country:US
Mailing Address - Phone:727-455-4108
Mailing Address - Fax:727-669-8417
Practice Address - Street 1:422 APPALOOSA RD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688
Practice Address - Country:US
Practice Address - Phone:727-455-4108
Practice Address - Fax:727-669-8417
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340259200Medicaid
FLPO2235OtherMEDICAL LICENSE
FL480027518OtherRAILROAD INDIVIDUAL ID
FL650859164OtherTAX ID
FL45440OtherBCBS GROUP ID
FLDE7435OtherRAILROAD GROUP ID
FL390073801Medicaid
FL65246OtherBCBS INDIVIDUAL ID
FL45440OtherBCBS GROUP ID
FLU08728Medicare UPIN
FLK0540Medicare ID - Type UnspecifiedMEDICARE GROUP ID