Healthcare Provider Details

I. General information

NPI: 1467911222
Provider Name (Legal Business Name): LELAND THOMAS MONTIERTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 OAK FOREST RD STE C
BLUFFTON SC
29910-4974
US

IV. Provider business mailing address

10 OAK FOREST RD STE C SUITE C
BLUFFTON SC
29910-4974
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-3006
  • Fax: 843-815-3737
Mailing address:
  • Phone: 843-815-3006
  • Fax: 843-815-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101025803
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97264
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101025803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: