Provider Demographics
NPI:1801186838
Name:MONTES, MOLLY (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MONTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 S REDWOOD RD
Mailing Address - Street 2:STE C211
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9336
Mailing Address - Country:US
Mailing Address - Phone:801-563-1975
Mailing Address - Fax:
Practice Address - Street 1:8822 S REDWOOD RD
Practice Address - Street 2:STE C211
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9336
Practice Address - Country:US
Practice Address - Phone:801-563-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8406656-1205208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program