Provider Demographics
NPI:1477621175
Name:BUFFALO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BUFFALO MEDICAL CENTER INC
Other - Org Name:WALWIN D METZGER, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALWIN
Authorized Official - Middle Name:DOWDA
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-229-3522
Mailing Address - Street 1:508 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3415
Mailing Address - Country:US
Mailing Address - Phone:813-229-3522
Mailing Address - Fax:813-225-3486
Practice Address - Street 1:508 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3415
Practice Address - Country:US
Practice Address - Phone:813-229-3522
Practice Address - Fax:813-225-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFS0939050OtherCHAMPUS
FLFS0939050OtherCHAMPUS
FL30515Medicare ID - Type Unspecified