ROGER MONTENEGRO (NPI# 1790929776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790929776 |
| Entity Type | Individual |
| Full Name | ROGER MONTENEGRO |
| Credential | MD |
| Practice Address |
130 Pablo St Lakeland FL 33803-3818 |
| Mailing Address |
1324 Lakeland Hills Blvd Attn: Medical Staff Office Lakeland FL 33805-4543 |
| Practice Telephone | 8632845941 |
| Practice Fax Number | 8632845199 |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2015-07-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
ME102410 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
130 PABLO ST |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803-3818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003810672 | Andrea Beale | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2005-06-10 |
| 1740804673 | Brian Win | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2020-06-06 |
| 1285284216 | Sandra Baffoe-bonnie | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-09-11 |
| 1215586458 | Jillian Railey | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-09-10 |
| 1194384362 | Ellen Davis | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-06-11 |
| 1558827592 | Rebecca N Levine | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-02-14 |
| 1124594007 | Rany Najeh Ahmad | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2018-10-18 |
| 1093224206 | Moezza Butler | Registered Nurse | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-09-20 |
| 1679092050 | Jessica Polk | Internal Medicine | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-09-16 |
| 1750803201 | Mary L Roy | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-07-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
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| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285935213 | Rodolfo G Miro Md Pa | Internal Medicine | 2108 Lakeland Hills Blvd, Lakeland, FL 33805-2906 | 2010-11-08 |
| 1699987800 | Mahmudul Haque | Internal Medicine | 805 East Garden Street, Lakeland, FL 33805-4616 | 2007-05-03 |
| 1508915943 | David J Vargas Md Pa | Internal Medicine | 1114 S Florida Avenue, Lakeland, FL 33803 | 2007-01-08 |
| 1154410272 | Izsak & Lamport,md,pa | Internal Medicine | 1222 S Florida Ave, Lakeland, FL 33803-2202 | 2006-10-12 |
| 1730585068 | Tammy Gebo-seaman | Internal Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2014-11-13 |
| 1013222058 | Lijian Wang | Internal Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2010-08-14 |
| 1881750305 | David J Vargas | Internal Medicine | 130 Pablo St, Lakeland, FL 33803-3818 | 2006-12-29 |
| 1760429062 | Joffre Rivera | Internal Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2006-06-02 |
| 1942262647 | Victor C Nwakakwa | Internal Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805 | 2006-04-06 |
| 1700857901 | Louis Stephen Saco | Internal Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805 | 2006-01-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.