Provider Demographics
NPI:1316268162
Name:CALIXTO-MONTANEZ, SERGIO (MD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:CALIXTO-MONTANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 SAMUELL BLVD
Mailing Address - Street 2:STE. 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7137
Mailing Address - Country:US
Mailing Address - Phone:214-381-1910
Mailing Address - Fax:214-381-2868
Practice Address - Street 1:6300 SAMUELL BLVD
Practice Address - Street 2:STE. 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7137
Practice Address - Country:US
Practice Address - Phone:214-381-1910
Practice Address - Fax:214-381-2868
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP40031207Q00000X
TXP4031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339723401Medicaid