Provider Demographics
NPI:1215183041
Name:GUILLERMO L MONTANEZ, M.D.,P.A.
Entity Type:Organization
Organization Name:GUILLERMO L MONTANEZ, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTANEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-8354
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-2105
Mailing Address - Country:US
Mailing Address - Phone:956-631-8354
Mailing Address - Fax:
Practice Address - Street 1:1200 E SAVANNAH AVE STE 18
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1728
Practice Address - Country:US
Practice Address - Phone:956-631-8354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071JAOtherBC/BS OF TEXAS
TX135513309Medicaid
TXD97568Medicare UPIN
TX135513309Medicaid