Basic Information
Provider Information
NPI: 1003800418
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONTIEL
FirstName: DAVID
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2055 NORMANDIE DR
Address2: SUITE 108
City: MONTGOMERY
State: AL
PostalCode: 361112732
CountryCode: US
TelephoneNumber: 3342696337
FaxNumber: 3348340657
Practice Location
Address1: 2055 NORMANDIE DR
Address2: SUITE 108
City: MONTGOMERY
State: AL
PostalCode: 361112732
CountryCode: US
TelephoneNumber: 3342884624
FaxNumber: 3342803628
Other Information
ProviderEnumerationDate: 08/31/2005
LastUpdateDate: 06/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085N0700X020134GAN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085N0700XME89649FLN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085N0700X00006280ALN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085R0202X020134GAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XME89649FLN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X00006280ALN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0204X6280ALY Allopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology

ID Information
IDTypeStateIssuerDescription
00004527305AL MEDICAID
00993079505AL MEDICAID
10671005AL MEDICAID
05150436401ALIDTFOTHER
00004527405AL MEDICAID
00996535505AL MEDICAID
00997259005AL MEDICAID
10817605AL MEDICAID
00004527605AL MEDICAID
00005886701ALIDTFOTHER
00992229505AL MEDICAID
00992840505AL MEDICAID
00008589005AL MEDICAID
10670805AL MEDICAID
00005886601ALIDTFOTHER
00008354705AL MEDICAID
10806805AL MEDICAID
27003100005FL MEDICAID


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