Provider Demographics
NPI:1275586398
Name:MONTES, MANUEL DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:DAVID
Last Name:MONTES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BELCHER RD S STE 4
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3307
Mailing Address - Country:US
Mailing Address - Phone:727-530-7585
Mailing Address - Fax:727-536-1831
Practice Address - Street 1:1000 BELCHER S RD STE 4
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3307
Practice Address - Country:US
Practice Address - Phone:727-530-7585
Practice Address - Fax:727-536-1831
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001887213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340243600Medicaid
1082500001OtherDME NUMBER
480006933OtherRAILROAD MEDICARE
1082500001Medicare NSC
T87844Medicare UPIN
65067Medicare ID - Type Unspecified