Healthcare Provider Details

I. General information

NPI: 1174571798
Provider Name (Legal Business Name): CHRISTY A MONTEGUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W AIRLINE HWY SUITE B
LA PLACE LA
70068-3817
US

IV. Provider business mailing address

429 W AIRLINE HWY SUITE B
LA PLACE LA
70068-3817
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-3344
  • Fax: 985-652-9320
Mailing address:
  • Phone: 985-652-3344
  • Fax: 985-652-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014286
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: