Provider Demographics
NPI:1699793661
Name:MONTALBANO, PAUL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:MONTALBANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6140 W CURTISIAN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-327-5600
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:6140 W CURTISIAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8907
Practice Address - Country:US
Practice Address - Phone:208-327-5600
Practice Address - Fax:208-327-5602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8076207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288294OtherOMAP
ID000010029707OtherREGENCE BLUE SHIELD
128615500OtherUS DEPARTMENT OF LABOR
ID000010163125OtherREGENCE BLUE SHIELD TALUS
ID1699793661Medicaid
ID76747OtherBLUE CROSS OF IDAHO
ID0214271OtherWA DEPT OF LABOR
ID76747OtherBLUE CROSS OF IDAHO
ID0214271OtherWA DEPT OF LABOR
1144538Medicare PIN
140008117Medicare PIN