Healthcare Provider Details

I. General information

NPI: 1841290293
Provider Name (Legal Business Name): DAN P. MONTZKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 LITTLE RD
TRINITY FL
34655
US

IV. Provider business mailing address

2055 LITTLE RD
TRINITY FL
34655-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-3090
  • Fax: 727-862-3023
Mailing address:
  • Phone: 727-862-3090
  • Fax: 727-862-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME68907
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME68907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: