Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | FTL# 43047 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | FTL# 43047 | TX |
NPI | 1205989191 |
---|---|
Provider Name | Richard Montilla |
First Address | Worcester, MA 01605-3646 |
Second Address | Worcester, MA 01605-3646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 26/03/2015 |