Provider Demographics
NPI:1841266285
Name:MONTES, VINCE N (MD)
Entity type:Individual
Prefix:
First Name:VINCE
Middle Name:N
Last Name:MONTES
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 1:8423 MUKILTEO SPEEDWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3237
Mailing Address - Country:US
Mailing Address - Phone:425-412-4311
Mailing Address - Fax:
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-814-6315
Practice Address - Fax:360-814-6261
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60096339207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0294317OtherL & I
WA1841266285Medicaid
AZ804288Medicaid
WAG8937146Medicare UPIN
WA0294317OtherL & I
WA1841266285Medicaid