Provider Demographics
NPI:1831294149
Name:MONTES, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:MONTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:712 39TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2454
Practice Address - Country:US
Practice Address - Phone:941-748-4602
Practice Address - Fax:941-747-9230
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2017-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME123811208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014967000Medicaid