Healthcare Provider Details

I. General information

NPI: 1285016220
Provider Name (Legal Business Name): MONTE V. A. SQUIERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MONIQUE-TERES SQUIERS MD

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S L ST
TACOMA WA
98405-3720
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1507
  • Fax: 253-403-1641
Mailing address:
  • Phone: 253-459-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA168474
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD61459681
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301108208
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12229851-1205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA168474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: