Provider Demographics
NPI:1477631422
Name:METSCH, HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:METSCH
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 1:6950 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3831
Mailing Address - Country:US
Mailing Address - Phone:951-686-8223
Mailing Address - Fax:951-686-9617
Practice Address - Street 1:6950 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3831
Practice Address - Country:US
Practice Address - Phone:951-686-8223
Practice Address - Fax:951-686-9617
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7819208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA58031Medicare UPIN