Provider Demographics
NPI:1972583193
Name:METZGER, CLARK STEPHEN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:STEPHEN
Last Name:METZGER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLARK
Other - Middle Name:
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2130 E JOHNSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6065
Mailing Address - Country:US
Mailing Address - Phone:850-494-6839
Mailing Address - Fax:833-985-3960
Practice Address - Street 1:2130 E JOHNSON AVE STE 130
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6065
Practice Address - Country:US
Practice Address - Phone:850-494-6839
Practice Address - Fax:833-985-3960
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13599174400000X
FLME57726207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261095700Medicaid
AL529910810Medicaid
AL051507227Medicare PIN
FL261095700Medicaid
FLCY609ZMedicare PIN