Provider Demographics
NPI:1144312638
Name:MONTROSE, PIERRE JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:JACOB
Last Name:MONTROSE
Suffix:
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 12717
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34979-2717
Mailing Address - Country:US
Mailing Address - Phone:772-871-7800
Mailing Address - Fax:772-871-7822
Practice Address - Street 1:2550 SE WALTON RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7168
Practice Address - Country:US
Practice Address - Phone:772-408-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69838283Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1050ZMedicaid
FLE1050AMedicare ID - Type Unspecified