Provider Demographics
NPI:1902878721
Name:MONTANEZ, GUILLERMO L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:L
Last Name:MONTANEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-2105
Mailing Address - Country:US
Mailing Address - Phone:956-631-8354
Mailing Address - Fax:956-631-8441
Practice Address - Street 1:1200 E SAVANNAH AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1727
Practice Address - Country:US
Practice Address - Phone:956-631-8354
Practice Address - Fax:956-631-8441
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135513309Medicaid
TX0071JAOtherBC/BS OF TEXAS
TX0071JAOtherBC/BS OF TEXAS
TXD97568Medicare UPIN