MEDICARE: DR. JUAN F MONTALVO M.D.

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	207V00000X	Obstetrics & Gynecology Physician	J5618	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB114525	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447268016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN F MONTALVO M.D.

Provider Business Mailing Address
First Line	:	10410 MEDICAL LOOP BLDG 3B
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6672
Country	:	US
Telephone Number	:	956-712-1294
Fax Number	:	956-712-8130

Provider Business Practice Location Address
First Line	:	10410 MEDICAL LOOP BLDG 3B
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6672
Country	:	US
Telephone Number	:	956-712-1294
Fax Number	:	956-712-8130

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	04/01/2022

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