Healthcare Provider Details

I. General information

NPI: 1649290370
Provider Name (Legal Business Name): ROBERT C. MONTANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 INTERSTATE 20
CANTON TX
75103-3593
US

IV. Provider business mailing address

400 HIGHLAND DR
SEATTLE WA
98109-3326
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-4841
  • Fax: 903-606-1201
Mailing address:
  • Phone: 312-375-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00046731
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM-2027
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036112106
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR2927
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: