Provider Demographics
NPI:1649270323
Name:MONTEMAYOR, KATHLEEN R (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:R
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2241
Mailing Address - Country:US
Mailing Address - Phone:727-844-3551
Mailing Address - Fax:727-847-0427
Practice Address - Street 1:6352 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2241
Practice Address - Country:US
Practice Address - Phone:727-844-3551
Practice Address - Fax:727-847-0427
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067205000Medicaid
FL268389000Medicaid
FLD27268Medicare UPIN