Provider Demographics
NPI:1992015184
Name:PIERE JACOB MONTROSE M D PA
Entity Type:Organization
Organization Name:PIERE JACOB MONTROSE M D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:MONTROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-871-7800
Mailing Address - Street 1:PO BOX 12717
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34979-2717
Mailing Address - Country:US
Mailing Address - Phone:772-871-7800
Mailing Address - Fax:772-871-7822
Practice Address - Street 1:5762 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 607
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4343
Practice Address - Country:US
Practice Address - Phone:772-871-7800
Practice Address - Fax:772-871-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME698382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254720100Medicaid