Provider Demographics
NPI:1790720274
Name:METZLER, PAUL S (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:METZLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E 20TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9039
Mailing Address - Country:US
Mailing Address - Phone:505-326-6400
Mailing Address - Fax:505-326-4606
Practice Address - Street 1:128 PEACHTREE LN
Practice Address - Street 2:STE B
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6782
Practice Address - Country:US
Practice Address - Phone:336-998-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR56419367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10026471OtherLOVELACE HP
NMP00380768OtherRR MEDICARE
UTT0506Medicaid
NM202007308OtherPRESBYTERIAN HP
CO83156062Medicaid
AZ075020Medicaid
NMNM006B96OtherBCBS
NM58006036Medicaid
UTT0506Medicaid