Provider Demographics
NPI:1972723278
Name:METAXAS, BILL JERRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:JERRY
Last Name:METAXAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1750 EL CAMINO REAL STE 106
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3210
Mailing Address - Country:US
Mailing Address - Phone:650-342-2420
Mailing Address - Fax:650-332-0278
Practice Address - Street 1:1750 EL CAMINO REAL STE 106
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3210
Practice Address - Country:US
Practice Address - Phone:650-342-2420
Practice Address - Fax:650-332-0278
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4757213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4757OtherBCBS INDIVIDUAL PROV. #
CAOTH000Medicare UPIN