Provider Demographics
NPI:1962606541
Name:MONTIEL HURTADO, CARLOS ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:MONTIEL HURTADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:709 W ORCHARD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:#105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-671-3345
Practice Address - Fax:360-650-1354
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60002202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2795270824OtherMYUTMB 2795270824-COMMERCIAL NUMBER
WA0275784OtherL&I
WA8685901OtherWA DSHS
WA238292OtherL & I
2795270824OtherMYUTMB 2795270824-COMMERCIAL NUMBER