Healthcare Provider Details

I. General information

NPI: 1194768283
Provider Name (Legal Business Name): RALPH A. MONTEAGUDO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SW MAIN ST.
WILBUR WA
99185-0582
US

IV. Provider business mailing address

100 3RD ST STE 1
DAVENPORT WA
99122-5008
US

V. Phone/Fax

Practice location:
  • Phone: 509-647-5321
  • Fax: 509-647-2238
Mailing address:
  • Phone: 509-725-7501
  • Fax: 509-725-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001334
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: