Healthcare Provider Details

I. General information

NPI: 1548206139
Provider Name (Legal Business Name): ST PETERSBURG MATERNAL FETAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH AVE S STE 340
ST PETERSBURG FL
33701-4619
US

IV. Provider business mailing address

625 6TH AVENEUE SOUTH SUITE 340
ST. PETERSBURG FL
33701-4734
US

V. Phone/Fax

Practice location:
  • Phone: 727-553-7903
  • Fax: 727-553-7905
Mailing address:
  • Phone: 727-553-7903
  • Fax: 727-553-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL MONTENEGRO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-553-7903