MEDICARE: DR. GARY GEORGE MONTALVO MD

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	207Y00000X	Otolaryngology Physician	5622	PR

General Provider Information

NPI Number	:	1437157096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY GEORGE MONTALVO MD

Provider Business Mailing Address
First Line	:	400 AVE DOMENECH
Second Line	:	STE 506
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-754-8625
Fax Number	:	787-746-6650

Provider Business Practice Location Address
First Line	:	400 AVE DOMENECH
Second Line	:	STE 506
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-754-8625
Fax Number	:	787-746-6650

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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