Provider Demographics
NPI:1841290293
Name:MONTZKA, DAN P (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:P
Last Name:MONTZKA
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 1:2055 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4421
Mailing Address - Country:US
Mailing Address - Phone:727-862-3090
Mailing Address - Fax:727-862-3023
Practice Address - Street 1:2055 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-862-3090
Practice Address - Fax:727-862-3023
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68907207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0074675000Medicaid
FL27647UMedicare PIN
FL27647Medicare ID - Type Unspecified
FL27647TMedicare PIN