MEDICARE: DR. RAUL EDWARD MONTEJO 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	2084N0400X	Neurology Physician	ME55755	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1922001072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL EDWARD MONTEJO MD

Provider Business Mailing Address
First Line	:	2401 FRIST BLVD STE 2B
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-460-7770
Fax Number	:	407-369-4295

Provider Business Practice Location Address
First Line	:	2401 FRIST BLVD STE 2B
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-460-7770
Fax Number	:	407-369-4295

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/26/2019

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