MEDICARE: MR. JOSE ROMMEL MONTANO RAYOS IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1063686582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE ROMMEL MONTANO RAYOS IDC

Provider Business Mailing Address
First Line	:	PSC 561
Second Line	:	BOX 1877
City	:	YAMAGUCHI
State	:	FPO AP
Zip	:	96310 0019
Country	:	JP
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 561
Second Line	:	BOX 1877
City	:	YAMAGUCHI
State	:	FPO AP
Zip	:	96310 0019
Country	:	JP
Telephone Number	:	315-253-6164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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