Provider Demographics
NPI:1013185230
Name:MONTALVO FITZPATRICK, JOSE ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:MONTALVO FITZPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:MONTALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 GALEN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4522
Mailing Address - Country:US
Mailing Address - Phone:857-268-3190
Mailing Address - Fax:
Practice Address - Street 1:1133 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-433-3322
Practice Address - Fax:321-433-3328
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16635208G00000X
CAA99902208G00000X
FLME135473208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)