Provider Demographics
NPI:1447268016
Name:MONTALVO, JUAN F (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:F
Last Name:MONTALVO
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 1:10410 MEDICAL LOOP BLDG 3B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6672
Mailing Address - Country:US
Mailing Address - Phone:956-712-1294
Mailing Address - Fax:956-712-8130
Practice Address - Street 1:10410 MEDICAL LOOP BLDG 3B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6672
Practice Address - Country:US
Practice Address - Phone:956-712-1294
Practice Address - Fax:956-712-8130
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5618207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114525OtherMEDICARE PTAN
TX121317506Medicaid
TXTXB114525OtherMEDICARE PTAN