Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 17724 | LA |
NPI | 1013917475 |
---|---|
Provider Name | Dr. Andrew Montz |
First Address | Mandeville, LA 70448-4664 |
Second Address | Mandeville, LA 70448-4664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B65662 | (02) | LA |