Healthcare Provider Details

I. General information

NPI: 1427292291
Provider Name (Legal Business Name): JASON MONTGOMERY CUELLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 W INDIANTOWN RD STE 212
JUPITER FL
33458-7535
US

IV. Provider business mailing address

658 W INDIANTOWN RD STE 212
JUPITER FL
33458-7535
US

V. Phone/Fax

Practice location:
  • Phone: 54-593-1753
  • Fax: 855-265-7167
Mailing address:
  • Phone: 305-459-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA135554
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME151896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: