Provider Demographics
NPI:1114255536
Name:MANUEL D. MONTES
Entity Type:Organization
Organization Name:MANUEL D. MONTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-530-7578
Mailing Address - Street 1:1000 BELCHER RD S
Mailing Address - Street 2:STE 4
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3321
Mailing Address - Country:US
Mailing Address - Phone:727-530-7578
Mailing Address - Fax:727-573-2048
Practice Address - Street 1:1000 BELCHER RD S
Practice Address - Street 2:STE 4
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3321
Practice Address - Country:US
Practice Address - Phone:727-530-7578
Practice Address - Fax:727-573-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001887332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65067Medicare PIN