Provider Demographics
NPI:1548239684
Name:MONTEFORTE, WILLIAM JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:MONTEFORTE
Suffix:JR
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 1:5409 DOON WAY
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2915
Mailing Address - Country:US
Mailing Address - Phone:425-330-6144
Mailing Address - Fax:425-330-6144
Practice Address - Street 1:5409 DOON WAY
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2915
Practice Address - Country:US
Practice Address - Phone:425-330-6144
Practice Address - Fax:425-330-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014272207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203980OtherLABOR & INDUSTRIES
WA8132250Medicaid
WAG8855805Medicare PIN
WA8132250Medicaid
WAP00265479Medicare PIN