Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 11622 | ND |
Y | 111NI0900X | Internist | 11622 | ND |
NPI | 1003015454 |
---|---|
Provider Name | Lance Monteau |
First Address | Bismarck, ND 58501-4949 |
Second Address | San Marcos, TX 78666-7969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 17/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15424 | (05) | ND |