Individual
DR. ENRIQUE C MONTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1119 HIGHLAND AVE STE 6, CLARKSTON, WA 99403-2836
(509) 254-2722
(509) 769-2022
Mailing address
1221 HIGHLAND AVE, CLARKSTON, WA 99403-2829
(509) 758-5511
(509) 769-2022
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
M- 10599
ID
208600000X
Surgery Physician
Primary
MD00047673
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000027381
ANTHEM
ID
01
—
020000619
TRAVLERS RAILROAD
ID
05
—
0433632
—
ID
01
—
4466435
AETNA
ID
01
—
MD00047673
STATE LICENCE
WA
Enumeration date
11/22/2005
Last updated
10/29/2013
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