1265913099 NPI number — DR. NICHOLAS A MONTES PHARMD

Table of content: DR. NICHOLAS A MONTES PHARMD (NPI 1265913099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265913099 NPI number — DR. NICHOLAS A MONTES PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTES
Provider First Name:
NICHOLAS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265913099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3185 WHISPERING TRAILS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33884-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-864-0080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617 US HIGHWAY 17 92 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAINES CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33844-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-419-1231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS58323 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)