Provider Demographics
NPI:1558478305
Name:MONTMINY, JOHN M (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MONTMINY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 848388
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8388
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:22 PINE ST
Practice Address - Street 2:THE HOSPITAL OF CENTRAL CONNECTICUT-BRISOL FAMILY CENTE
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6948
Practice Address - Country:US
Practice Address - Phone:860-545-3112
Practice Address - Fax:904-446-3013
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-03-27
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Provider Licenses
StateLicense IDTaxonomies
CT041878207PE0005X, 207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001418789Medicaid
CTI04715Medicare UPIN
CT080001682Medicare ID - Type UnspecifiedFOR CLINIC C00814