Healthcare Provider Details

I. General information

NPI: 1558478305
Provider Name (Legal Business Name): JOHN M MONTMINY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PINE ST THE HOSPITAL OF CENTRAL CONNECTICUT-BRISOL FAMILY CENTE
BRISTOL CT
06010-6948
US

IV. Provider business mailing address

PO BOX 848388
BOSTON MA
02284-8388
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-3112
  • Fax: 904-446-3013
Mailing address:
  • Phone: 904-446-3451
  • Fax: 904-446-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number041878
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number041878
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number041878
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: