Provider Demographics
NPI:1649284712
Name:MONTENEGRO, ROBERT PALENCIA (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PALENCIA
Last Name:MONTENEGRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-4521
Mailing Address - Fax:320-634-2262
Practice Address - Street 1:10 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1820
Practice Address - Country:US
Practice Address - Phone:320-634-4521
Practice Address - Fax:320-634-2262
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
142928OtherUCARE
01-10121OtherMEDICA
01-10122OtherMEDICA
MN133M5MOOtherBLUE CROSS
HP36961OtherHEALTH PARTNERS
39-44354OtherMEDICA
1032853OtherPREFERRED ONE
01-10120OtherMEDICA
1705983OtherARAZ
MN133M5MOOtherBLUE CROSS