Provider Demographics
NPI:1003007360
Name:MONTEMURNO, TINA DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:DEBORAH
Last Name:MONTEMURNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12157 POWHATAN TRL
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7121
Mailing Address - Country:US
Mailing Address - Phone:917-848-0893
Mailing Address - Fax:
Practice Address - Street 1:12157 POWHATAN TRL
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7121
Practice Address - Country:US
Practice Address - Phone:917-848-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238503207L00000X
NJ25MA08393900207L00000X
CODR.0067713207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000210484Medicaid