Provider Demographics
NPI:1568667418
Name:MONTES, ISMAEL (RRT,RCP)
Entity Type:Individual
Prefix:MR
First Name:ISMAEL
Middle Name:
Last Name:MONTES
Suffix:
Gender:M
Credentials:RRT,RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 N. JK POWELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472
Mailing Address - Country:US
Mailing Address - Phone:910-642-0202
Mailing Address - Fax:910-642-0110
Practice Address - Street 1:1014 N. JK POWELL BOULEVARD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472
Practice Address - Country:US
Practice Address - Phone:910-642-0202
Practice Address - Fax:910-642-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA2134227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7492702Medicaid