Provider Demographics
NPI:1447211008
Name:MONTERO, J. A (M D)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:A
Last Name:MONTERO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 MCAULEY BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8371
Mailing Address - Country:US
Mailing Address - Phone:405-848-8289
Mailing Address - Fax:405-752-9491
Practice Address - Street 1:4205 MCAULEY BLVD.
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8371
Practice Address - Country:US
Practice Address - Phone:405-848-8289
Practice Address - Fax:405-752-9491
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35059Medicare UPIN