Provider Demographics
NPI:1588789788
Name:MONTANA, ANTHONY W (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:MONTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:2111 HERNDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6301
Practice Address - Country:US
Practice Address - Phone:559-299-2200
Practice Address - Fax:559-299-1323
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG32147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07334ZMedicare PIN
CACF584ZMedicare UPIN