Provider Demographics
NPI:1144289851
Name:METZLER, ERIC WALBURN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WALBURN
Last Name:METZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:EUGENE
Other - Last Name:METZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-1279
Mailing Address - Country:US
Mailing Address - Phone:505-858-1222
Mailing Address - Fax:818-861-3324
Practice Address - Street 1:1203 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-5816
Practice Address - Country:US
Practice Address - Phone:575-835-2724
Practice Address - Fax:575-835-4378
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012897207Q00000X
NMMD2010-0098207Q00000X, 207QH0002X, 207QG0300X
NMRS2009-0379207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76133737Medicaid
ME201836OtherNGS
ME121620099Medicaid
NM76133737Medicaid
MEA58657Medicare UPIN
ME201836OtherNGS
ME011293OtherANTHEM