Basic Information
| Provider Information | |||||||||
| NPI: | 1003800418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTIEL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 00006280 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | ME89649 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 020134 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 00006280 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME89649 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 020134 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 6280 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000045273 | 05 | AL | MEDICAID | 000045276 | 05 | AL | MEDICAID | 000085890 | 05 | AL | MEDICAID | 009930795 | 05 | AL | MEDICAID | 000058867 | 01 | AL | IDTF | OTHER | 009922295 | 05 | AL | MEDICAID | 000058866 | 01 | AL | IDTF | OTHER | 009965355 | 05 | AL | MEDICAID | 009972590 | 05 | AL | MEDICAID | 270031000 | 05 | FL | MEDICAID | 000083547 | 05 | AL | MEDICAID | 108068 | 05 | AL | MEDICAID | 108176 | 05 | AL | MEDICAID | 000045274 | 05 | AL | MEDICAID | 009928405 | 05 | AL | MEDICAID | 051504364 | 01 | AL | IDTF | OTHER | 106708 | 05 | AL | MEDICAID | 106710 | 05 | AL | MEDICAID |