Provider Demographics
NPI:1013998178
Name:MONTEMAYOR, RAUL M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:M
Last Name:MONTEMAYOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2829 BABCOCK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6028
Mailing Address - Country:US
Mailing Address - Phone:210-614-5855
Mailing Address - Fax:210-614-6240
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-614-5855
Practice Address - Fax:210-614-6240
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF8582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Z501OtherTX BC/BS
TX742778964OtherTX IDN
TX117263701Medicaid
TX83Z501OtherTX BC/BS
TXB24971Medicare UPIN