Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME 42966 | FL |
NPI | 1245260637 |
---|---|
Provider Name | Dr. Raul Montenegro |
First Address | St Petersburg, FL 33701-4619 |
Second Address | St Petersburg, FL 33701-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 07/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D85539 | (02) | FL |