Provider Demographics
NPI:1730143355
Name:METZGER, FREDRIC ALEXANDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:ALEXANDER
Last Name:METZGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:915 N GRAND BLVD
Mailing Address - Street 2:MEDICAL PSYCHOLOGY 116B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1621
Mailing Address - Country:US
Mailing Address - Phone:314-289-6371
Mailing Address - Fax:314-289-7086
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:MEDICAL PSYCHOLOGY 116B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-289-6371
Practice Address - Fax:314-289-7086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical