Provider Demographics
NPI:1962437228
Name:MONAST, DALE R
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:MONAST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3002
Mailing Address - Country:US
Mailing Address - Phone:727-586-3668
Mailing Address - Fax:727-588-0490
Practice Address - Street 1:1680 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3002
Practice Address - Country:US
Practice Address - Phone:727-586-3668
Practice Address - Fax:727-588-0490
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029738100Medicaid
T84661Medicare UPIN
T84661Medicare UPIN