Provider Demographics
NPI:1679840235
Name:LAUREN MONTI MD LLC
Entity Type:Organization
Organization Name:LAUREN MONTI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-828-9495
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-828-9495
Mailing Address - Fax:124-823-1230
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-828-9495
Practice Address - Fax:214-823-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K67WOtherMEDICARE ID
TXE56708Medicare UPIN