MEDICARE: GARY MONTSDEOCA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0024449	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508899402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MONTSDEOCA M.D.

Provider Business Mailing Address
First Line	:	4343 SUN N LAKE BLVD
Second Line	:	SUITE B
City	:	SEBRING
State	:	FL
Zip	:	33872-2162
Country	:	US
Telephone Number	:	863-382-9100
Fax Number	:	863-382-8928

Provider Business Practice Location Address
First Line	:	4343 SUN N LAKE BLVD
Second Line	:	SUITE B
City	:	SEBRING
State	:	FL
Zip	:	33872-2162
Country	:	US
Telephone Number	:	863-382-9100
Fax Number	:	863-382-8928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/24/2008

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