Provider Demographics
NPI:1609831098
Name:MONTERO, EMILIO FRANCISCO (MD, PA)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:FRANCISCO
Last Name:MONTERO
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3004
Mailing Address - Country:US
Mailing Address - Phone:863-682-2117
Mailing Address - Fax:863-683-7915
Practice Address - Street 1:1812 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3004
Practice Address - Country:US
Practice Address - Phone:863-682-2117
Practice Address - Fax:863-683-7915
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53428Medicare ID - Type Unspecified
FLD56511Medicare UPIN