Provider Demographics
NPI:1033246228
Name:MONTEGUT, WALTON JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTON
Middle Name:JAMES
Last Name:MONTEGUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7812
Mailing Address - Country:US
Mailing Address - Phone:949-706-2711
Mailing Address - Fax:
Practice Address - Street 1:359 SAN MIGUEL DR
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7812
Practice Address - Country:US
Practice Address - Phone:949-706-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG06533Medicare UPIN