Provider Demographics
NPI:1225146731
Name:MONTANO, MARK JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:MONTANO
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 1:9330 S UNIVERSITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5049
Mailing Address - Country:US
Mailing Address - Phone:303-346-3627
Mailing Address - Fax:303-683-9392
Practice Address - Street 1:9330 S UNIVERSITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5049
Practice Address - Country:US
Practice Address - Phone:303-346-3627
Practice Address - Fax:303-683-9392
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH43859Medicare UPIN
C439628Medicare PIN