Healthcare Provider Details

I. General information

NPI: 1902878721
Provider Name (Legal Business Name): GUILLERMO L MONTANEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E SAVANNAH AVE SUITE 18
MCALLEN TX
78503-1727
US

IV. Provider business mailing address

PO BOX 2105
MCALLEN TX
78505-2105
US

V. Phone/Fax

Practice location:
  • Phone: 956-631-8354
  • Fax: 956-631-8441
Mailing address:
  • Phone: 956-631-8354
  • Fax: 956-631-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH3711
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: