Healthcare Provider Details

I. General information

NPI: 1982892550
Provider Name (Legal Business Name): VERNON MONTOYA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 SW STATE ROAD 47
LAKE CITY FL
32025-0453
US

IV. Provider business mailing address

795 SW STATE ROAD 47
LAKE CITY FL
32025-0453
US

V. Phone/Fax

Practice location:
  • Phone: 386-758-7822
  • Fax: 386-758-7789
Mailing address:
  • Phone: 386-758-7822
  • Fax: 386-758-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VERNON P MONTOYA
Title or Position: OWNER
Credential: MD
Phone: 386-758-7822