Provider Demographics
NPI:1689022170
Name:CHARLES L METZGER MD PA
Entity Type:Organization
Organization Name:CHARLES L METZGER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:713-333-9333
Mailing Address - Street 1:5420 WEST LOOP S
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2107
Mailing Address - Country:US
Mailing Address - Phone:713-333-9333
Mailing Address - Fax:713-333-9343
Practice Address - Street 1:5420 WEST LOOP S
Practice Address - Street 2:SUITE 4300
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2107
Practice Address - Country:US
Practice Address - Phone:713-333-9333
Practice Address - Fax:713-333-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4152207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
87921SOtherBLUE CROSS BLUE SHIELD
87921SOtherBLUE CROSS BLUE SHIELD
TXF99676Medicare UPIN