1063430171 NPI number — DANIEL STEWART METZINGER M.D.

Table of content: DANIEL STEWART METZINGER M.D. (NPI 1063430171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063430171 NPI number — DANIEL STEWART METZINGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METZINGER
Provider First Name:
DANIEL
Provider Middle Name:
STEWART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063430171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S JACKSON ST ACB/2ND FLOOR
Provider Second Line Business Mailing Address:
DEPT OB/GYN ATT VICKI MASTERSON
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 S JACKSON ST
Provider Second Line Business Practice Location Address:
BROWN CANCER CENTER
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-561-7220
Provider Business Practice Location Address Fax Number:
502-561-7327
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0201X , with the licence number:  31317 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000007338Z . This is a "HUMANA PSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000021037N . This is a "HUMANA FOUNDATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64034218 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200336380 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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