Provider Demographics
NPI:1194768283
Name:MONTEAGUDO, RALPH A (DO)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:MONTEAGUDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-5008
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:214 SW MAIN ST.
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:WA
Practice Address - Zip Code:99185-0582
Practice Address - Country:US
Practice Address - Phone:509-647-5321
Practice Address - Fax:509-647-2238
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00229831OtherMEDICARE RAILROAD
WA7101132Medicaid
WA7117450Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA199002OtherDEPT. OF L & I
WA8132342Medicaid
WA8132342Medicaid
WAG8854782Medicare PIN
WA7101132Medicaid
WA199002OtherDEPT. OF L & I
WA508529Medicare Oscar/Certification
WA508530Medicare Oscar/Certification