Provider Demographics
NPI:1508927088
Name:METZGER, PAUL KENJI (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENJI
Last Name:METZGER
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:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-0503
Mailing Address - Country:US
Mailing Address - Phone:209-267-9024
Mailing Address - Fax:
Practice Address - Street 1:817 S STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2622
Practice Address - Country:US
Practice Address - Phone:209-223-2610
Practice Address - Fax:209-257-1463
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G643140Medicare ID - Type Unspecified
CAB55047Medicare UPIN