Provider Demographics
NPI:1790864593
Name:METZ, DONALD R (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:METZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536
Mailing Address - Country:US
Mailing Address - Phone:281-479-5941
Mailing Address - Fax:281-542-1861
Practice Address - Street 1:2910 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536
Practice Address - Country:US
Practice Address - Phone:281-479-5941
Practice Address - Fax:281-542-1861
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67412Medicare UPIN
TX85160JMedicare ID - Type Unspecified