Provider Demographics
NPI:1831103316
Name:METZGER, NICHOLAS (MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
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 1:475 ELM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3764
Mailing Address - Country:US
Mailing Address - Phone:214-222-8150
Mailing Address - Fax:833-326-8089
Practice Address - Street 1:191 N UNION AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4447
Practice Address - Country:US
Practice Address - Phone:830-620-1191
Practice Address - Fax:830-620-1190
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25764208600000X
TXN6492208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ736704Medicaid
AZ736704Medicaid
H73314Medicare UPIN