Healthcare Provider Details

I. General information

NPI: 1255327763
Provider Name (Legal Business Name): MARC MONTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARSON ST
JONESBORO AR
72401-3104
US

IV. Provider business mailing address

300 CARSON ST
JONESBORO AR
72401-3104
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-5296
  • Fax: 870-910-7713
Mailing address:
  • Phone: 870-932-5296
  • Fax: 870-910-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberE1106
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: