Provider Demographics
NPI:1497731384
Name:MONTIGUE, TRE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRE
Middle Name:
Last Name:MONTIGUE
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:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7348207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2122OtherBCBS
TX040154905Medicaid
TX040154907OtherMEDICAID CSHCN
TX040154908Medicaid
TX040154904Medicaid
TX8EH615OtherBCBS TX
TX040154906Medicaid
TX8G2122OtherBCBS
TX8A2117Medicare PIN
TX8EH615OtherBCBS TX
TX040154906Medicaid
TX040154908Medicaid
TX8L4424Medicare PIN