Healthcare Provider Details

I. General information

NPI: 1720185598
Provider Name (Legal Business Name): ANTHONY MONTANARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

511 SW 10TH AVE STE 1301
PORTLAND OR
97205-2714
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD12806
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: