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General NPI Number Information
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NPI Number | 1508899402
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Entity Type | Individual
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Provider Name | GARY MONTSDEOCA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 4343 SUN N LAKE BLVD SUITE B
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City | SEBRING
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State | FL
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Zip | 33872-2162
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Country | US
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Telephone | 863-382-9100
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Fax | 863-382-8928
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Provider Business Mailing Address
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Address Line | 4343 SUN N LAKE BLVD SUITE B
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City | SEBRING
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State | FL
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Zip | 33872-2162
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Country | US
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Telephone | 863-382-9100
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Fax | 863-382-8928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0024449
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License Number State | FL
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