Provider Demographics
NPI:1881774438
Name:MONTIGUE, BETH C (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:C
Last Name:MONTIGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:4001 LONG PRAIRIE RD
Practice Address - Street 2:STE 140
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1525
Practice Address - Country:US
Practice Address - Phone:972-691-2388
Practice Address - Fax:972-691-2766
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036860702Medicaid
1750369203OtherGRP NPI NUMBER
UT140442827Medicaid
TX1894758OtherUHC PIN
TX3138743OtherCIGNA PIN
TX5943758OtherAETNA PIN
TXMONB167468OtherCCHIP PIN
TX00U87ZOtherBCBSTX GRP PIN
TX8K4010OtherBCBSTX IND PIN
TX140442867Medicaid
TX214966OtherFIRSTHEALTH PIN
G95998Medicare UPIN
TX140442867Medicaid
TX00410KMedicare PIN