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General NPI Number Information
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NPI Number | 1003095274
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Entity Type | Organization
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Legal Business Name | R EDWARD MONTEJO MD PA
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 942 SEAWAY DR
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City | FORT PIERCE
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State | FL
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Zip | 34949-3123
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Country | US
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Telephone | 772-467-0348
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Fax | 772-466-8286
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Provider Business Mailing Address
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Address Line | 942 SEAWAY DR
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City | FORT PIERCE
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State | FL
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Zip | 34949-3123
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Country | US
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Telephone | 772-467-0348
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Fax | 772-466-8286
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MARCY MONTEJO
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Credential |
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Telephone | 772-467-0348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME55755
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License Number State | FL
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