Provider Demographics
NPI:1750536876
Name:MONTFORT, WILLIAM FITCH IV (IDC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:FITCH
Last Name:MONTFORT
Suffix:IV
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VERNON AVE BLDG 89-A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-7018
Mailing Address - Country:US
Mailing Address - Phone:850-235-5092
Mailing Address - Fax:850-230-7208
Practice Address - Street 1:101 VERNON AVE BLDG 89-A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-7018
Practice Address - Country:US
Practice Address - Phone:850-235-5092
Practice Address - Fax:850-230-7208
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman