Provider Demographics
NPI:1548732738
Name:MONTES DE OCA, MANUEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:MONTES DE OCA
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 1:121 NE 3RD ST APT 1305
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1052
Mailing Address - Country:US
Mailing Address - Phone:561-360-0503
Mailing Address - Fax:
Practice Address - Street 1:121 NE 3RD ST APT 1305
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1052
Practice Address - Country:US
Practice Address - Phone:561-360-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2025-08-04
Deactivation Date:2022-02-23
Deactivation Code:
Reactivation Date:2022-03-29
Provider Licenses
StateLicense IDTaxonomies
NY315008207R00000X
390200000X
IL036.159998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program