Provider Demographics
NPI:1356410161
Name:METZ, TIMOTHY J (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:METZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5105 S PENNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2990
Mailing Address - Country:US
Mailing Address - Phone:605-338-0500
Mailing Address - Fax:605-335-3505
Practice Address - Street 1:911 E 20TH ST STE 602
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1048
Practice Address - Country:US
Practice Address - Phone:605-338-7098
Practice Address - Fax:605-335-3505
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4713207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5700900Medicaid
MN590007700Medicaid
MN96D03MEOtherBLUE CROSS MN
SD4997536OtherBLUE CROSS SD
IA532754Medicaid