Provider Demographics
NPI:1174698088
Name:MONTANO, NOELLE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:ELIZABETH
Last Name:MONTANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 OAK LAWN AVE UNIT 192749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4688
Mailing Address - Country:US
Mailing Address - Phone:844-389-5711
Mailing Address - Fax:877-880-2039
Practice Address - Street 1:5125 SKYLINE RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:844-389-5711
Practice Address - Fax:877-880-2039
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000492972085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8488934Medicaid
WA8488934Medicaid