Provider Demographics
NPI:1255581948
Name:MICHAEL A. MONMOUTH M.D., P.A.
Entity type:Organization
Organization Name:MICHAEL A. MONMOUTH M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-333-5114
Mailing Address - Street 1:2020 NASA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3683
Mailing Address - Country:US
Mailing Address - Phone:281-333-5114
Mailing Address - Fax:281-333-4965
Practice Address - Street 1:2020 NASA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3683
Practice Address - Country:US
Practice Address - Phone:281-333-5114
Practice Address - Fax:281-333-4965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASA BONE & JOINT L.L.P.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6897207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000G82R4Medicaid
TXA66576Medicare UPIN
TX00G82RMedicare PIN