Provider Demographics
NPI:1851683411
Name:MONTHAN, JESSICA M (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MONTHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2001 N. CENTRO FAMILIAR 87105
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4592
Mailing Address - Country:US
Mailing Address - Phone:505-873-7400
Mailing Address - Fax:505-224-8797
Practice Address - Street 1:2001 EL CENTRO FAMILIAR BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4592
Practice Address - Country:US
Practice Address - Phone:505-873-7400
Practice Address - Fax:505-877-4400
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine