Provider Demographics
NPI:1134461676
Name:MONT, JAY LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:LEWIS
Last Name:MONT
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 1:6666 HARWIN DR
Mailing Address - Street 2:#480
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2292
Mailing Address - Country:US
Mailing Address - Phone:713-974-6564
Mailing Address - Fax:
Practice Address - Street 1:6666 HARWIN DR
Practice Address - Street 2:#480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2292
Practice Address - Country:US
Practice Address - Phone:713-974-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7573132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager