Provider Demographics
NPI:1093817876
Name:MONTER PEDIATRICS, INC
Entity type:Organization
Organization Name:MONTER PEDIATRICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-926-4203
Mailing Address - Street 1:7620 GUNN HWY
Mailing Address - Street 2:STE 190
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3144
Mailing Address - Country:US
Mailing Address - Phone:813-926-4203
Mailing Address - Fax:813-792-7511
Practice Address - Street 1:7620 GUNN HWY
Practice Address - Street 2:STE 190
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3144
Practice Address - Country:US
Practice Address - Phone:813-926-4203
Practice Address - Fax:813-792-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7491OtherBLUE CROSS BLUE SHIELD
123125OtherHUMANA
7491OtherBLUE CROSS BLUE SHIELD
=========OtherCIGNA
=========OtherAVMED