Provider Demographics
NPI:1811997018
Name:MONTEVERDI, ANTHONY J (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MONTEVERDI
Suffix:
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 1:1345 NW WALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1972
Mailing Address - Country:US
Mailing Address - Phone:541-382-1395
Mailing Address - Fax:541-382-6576
Practice Address - Street 1:1345 NW WALL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1972
Practice Address - Country:US
Practice Address - Phone:541-382-1395
Practice Address - Fax:541-382-6576
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD261392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR133371Medicare PIN
ORI46230Medicare UPIN