NPIMap

Organization Active NPI

R Edward Montejo MD PA

  • Neurology Physician
  • Fort Pierce, FL
National Provider Identifier
1003095274
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME55755 Issued in FL
Legal business name
R EDWARD MONTEJO MD PA
Practice address
942 Seaway Dr
Fort Pierce, FL 34949-3123
Phone
(772) 467-0348
Fax
(772) 466-8286
NPI assigned
Oct 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcy Montejo
Title
Account Manager
Phone
(772) 467-0348

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X ME55755 FL Primary

Addresses

Primary practice location

942 Seaway Dr
Fort Pierce, FL 34949-3123

Mailing address

942 Seaway Dr
Fort Pierce, FL 34949-3123
Phone (772) 467-0348

Other identifiers 1

IdentifierTypeStateIssuer
273461300MedicaidFL

National Provider Directory

National Provider Directory

Locations

942 Seaway Dr
Fort Pierce, FL 34949
Phone (772) 467-0348

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1003095274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 SEAWAY DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349493123",
            "telephone_number": "772-467-0348",
            "fax_number": "772-466-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "942 SEAWAY DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349493123",
            "telephone_number": "772-467-0348",
            "fax_number": "772-466-8286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R EDWARD MONTEJO MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "MONTEJO",
        "authorized_official_first_name": "MARCY",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "772-467-0348"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME55755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273461300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.