Provider Demographics
NPI:1811280266
Name:BARBARA MONTFORD M.D.,P.A.
Entity type:Organization
Organization Name:BARBARA MONTFORD M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-696-0806
Mailing Address - Street 1:18020 SW 78TH PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6229
Mailing Address - Country:US
Mailing Address - Phone:305-696-0806
Mailing Address - Fax:
Practice Address - Street 1:1190 NW 95TH ST STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33150-2064
Practice Address - Country:US
Practice Address - Phone:305-696-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371036000Medicaid
FL17717AMedicare PIN
FL371036000Medicaid