Provider Demographics
NPI:1861671364
Name:MONTEJO, EUSEBIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:EUSEBIO
Middle Name:M
Last Name:MONTEJO
Suffix:
Gender:M
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:PO BOX 3159
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-3159
Mailing Address - Country:US
Mailing Address - Phone:361-668-9600
Mailing Address - Fax:
Practice Address - Street 1:13627 ADOBE CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5460
Practice Address - Country:US
Practice Address - Phone:530-902-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95635207Q00000X
TXN3905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA95635AMedicare PIN
CA00A956350Medicare PIN
CAWA95635DMedicare UPIN
CA00A956353Medicare PIN
CA00A956352Medicare PIN
CAWA95635CMedicare UPIN
TX6564520001Medicare NSC
CABB601ZMedicare PIN
CA00A956354Medicare PIN
CAWA95635BMedicare UPIN
CA00A956351Medicare PIN
CA00A956355Medicare PIN