Provider Demographics
NPI:1447228606
Name:MONTANO, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
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 1:1919 LATHROP ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5930
Mailing Address - Country:US
Mailing Address - Phone:907-452-8151
Mailing Address - Fax:907-452-8153
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5930
Practice Address - Country:US
Practice Address - Phone:907-452-8151
Practice Address - Fax:907-452-8153
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1335208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 1335Medicaid
AKK0000BLBNCMedicare PIN
AKC96917Medicare UPIN