Provider Demographics
NPI:1003800418
Name:MONTIEL, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MONTIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 NORMANDIE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-269-6337
Mailing Address - Fax:334-834-0657
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000062802085N0700X, 2085R0202X
FLME896492085N0700X, 2085R0202X
GA0201342085N0700X, 2085R0202X
AL62802085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045273Medicaid
AL000045276Medicaid
AL000085890Medicaid
AL009930795Medicaid
AL000058867OtherIDTF
AL009922295Medicaid
AL000058866OtherIDTF
AL009965355Medicaid
AL009972590Medicaid
FL270031000Medicaid
AL000083547Medicaid
AL108068Medicaid
AL108176Medicaid
AL000045274Medicaid
AL009928405Medicaid
AL051504364OtherIDTF
AL106708Medicaid
AL106710Medicaid
AL000083547Medicaid
AL108068Medicaid
AL051504364OtherIDTF
AL000085890Medicaid
AL009930795Medicaid
FL37500ZMedicare PIN