Provider Demographics
NPI:1699887299
Name:NINE-MONTANEZ, CARLOS JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JOSE
Last Name:NINE-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 1:85 WHISPERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1136
Mailing Address - Country:US
Mailing Address - Phone:985-781-8565
Mailing Address - Fax:
Practice Address - Street 1:105 MEDICAL CENTER DR
Practice Address - Street 2:STE. 207
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5544
Practice Address - Country:US
Practice Address - Phone:985-847-0024
Practice Address - Fax:985-847-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.11048R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1655643Medicaid
LA1655643Medicaid
5U953Medicare ID - Type Unspecified