MEDICARE: VERNON MONTOYA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician

General Provider Information

NPI Number	:	1982892550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNON MONTOYA MD PA

Provider Business Mailing Address
First Line	:	795 SW STATE ROAD 47
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0453
Country	:	US
Telephone Number	:	386-758-7822
Fax Number	:	386-758-7789

Provider Business Practice Location Address
First Line	:	795 SW STATE ROAD 47
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0453
Country	:	US
Telephone Number	:	386-758-7822
Fax Number	:	386-758-7789

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VERNON P MONTOYA
Credential	:	MD
Telephone Number	:	386-758-7822

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/16/2007

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