Provider Demographics
NPI:1013919810
Name:MONTANARO, LOUIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:MONTANARO
Suffix:III
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 1:4300 N JOSEY LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4602
Mailing Address - Country:US
Mailing Address - Phone:972-939-6515
Mailing Address - Fax:972-939-6507
Practice Address - Street 1:4300 N JOSEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4602
Practice Address - Country:US
Practice Address - Phone:972-939-6515
Practice Address - Fax:972-939-6507
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXJ0604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00025GMedicare ID - Type Unspecified
TXD42671Medicare UPIN