Provider Demographics
NPI:1568638369
Name:METCALF, MIGNON (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MIGNON
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR STE 5000
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3410
Mailing Address - Country:US
Mailing Address - Phone:561-623-7955
Mailing Address - Fax:561-264-8233
Practice Address - Street 1:1411 N FLAGLER DR STE 5000
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3410
Practice Address - Country:US
Practice Address - Phone:561-623-7955
Practice Address - Fax:561-264-8233
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109576208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008300500Medicaid