Provider Demographics
NPI:1851386825
Name:METZGER, WALWIN DOWDA (MD)
Entity Type:Individual
Prefix:DR
First Name:WALWIN
Middle Name:DOWDA
Last Name:METZGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3415
Mailing Address - Country:US
Mailing Address - Phone:813-229-3522
Mailing Address - Fax:813-225-3486
Practice Address - Street 1:508 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3415
Practice Address - Country:US
Practice Address - Phone:813-229-3522
Practice Address - Fax:813-225-3486
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFS0939050OtherCHAMPUS
FL30515Medicare ID - Type Unspecified
FLFS0939050OtherCHAMPUS