Provider Demographics
NPI:1508195405
Name:MANUEL MONTES
Entity Type:Organization
Organization Name:MANUEL MONTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-530-7585
Mailing Address - Street 1:1000 BELCHER RD S
Mailing Address - Street 2:STE 4
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3321
Mailing Address - Country:US
Mailing Address - Phone:757-530-7585
Mailing Address - Fax:757-536-1831
Practice Address - Street 1:1000 BELCHER RD S
Practice Address - Street 2:STE 4
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3321
Practice Address - Country:US
Practice Address - Phone:757-530-7585
Practice Address - Fax:757-536-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001887213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65067Medicare PIN