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NPI Code Detail

MEDICARE: DR. GRACE A MONTENEGRO M.D.

MEDICARE: DR. GRACE A MONTENEGRO 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
1208C00000XColon & Rectal Surgery Physician2013017017MO

General Provider Information

NPI Number : 1497948087
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACE A MONTENEGRO M.D.
Provider Business Mailing Address
First Line : 1008 S SPRING AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2520
Country : US
Telephone Number : 314-977-3530
Fax Number :
Provider Business Practice Location Address
First Line : 1008 S SPRING AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2520
Country : US
Telephone Number : 314-977-3530
Fax Number : 314-977-1630
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2007
Last Update Date : 02/17/2021

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