Provider Demographics
NPI:1134183031
Name:MONTES, EDUARDO (DPM)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MONTES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 S HIGHWAY 92 STE 114
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6693
Mailing Address - Country:US
Mailing Address - Phone:520-515-3668
Mailing Address - Fax:520-220-5193
Practice Address - Street 1:2151 S HIGHWAY 92 STE 114
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6693
Practice Address - Country:US
Practice Address - Phone:520-515-3668
Practice Address - Fax:520-220-5193
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0519213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527111Medicaid
AZ527111Medicaid
AZZ103289Medicare PIN