Provider Demographics
NPI:1598902215
Name:HARWOOD, MONTE KYLE (PA)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:KYLE
Last Name:HARWOOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 FM 407 STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7193
Mailing Address - Country:US
Mailing Address - Phone:972-317-1110
Mailing Address - Fax:972-317-1556
Practice Address - Street 1:2012 FM 407 STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-7193
Practice Address - Country:US
Practice Address - Phone:972-317-1110
Practice Address - Fax:972-317-1556
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA1802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB158853Medicare PIN
TXTXB158852Medicare PIN
TXTXB158851Medicare PIN