Healthcare Provider Details

I. General information

NPI: 1568667418
Provider Name (Legal Business Name): ISMAEL MONTES RRT,RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 N. JK POWELL BOULEVARD
WHITEVILLE NC
28472
US

IV. Provider business mailing address

1014 N. JK POWELL BOULEVARD
WHITEVILLE NC
28472
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-0202
  • Fax: 910-642-0110
Mailing address:
  • Phone: 910-642-0202
  • Fax: 910-642-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberA2134
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: