Provider Demographics
NPI:1487731063
Name:MONTEMAYOR, ANDREW G (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:MONTEMAYOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1946 YOUNG ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2150
Mailing Address - Country:US
Mailing Address - Phone:808-973-7320
Mailing Address - Fax:808-973-7325
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:808-522-4232
Practice Address - Fax:808-522-4397
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-12772208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI553869Medicaid
HI00C0070981OtherHMSA
HII11178Medicare UPIN
HI56954Medicare ID - Type Unspecified