Healthcare Provider Details

I. General information

NPI: 1508178583
Provider Name (Legal Business Name): IVAN MONTOYA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

151 CAPE FLORIDA DR
KEY BISCAYNE FL
33149-2708
US

V. Phone/Fax

Practice location:
  • Phone: 305-378-2381
  • Fax: 888-824-4950
Mailing address:
  • Phone: 305-378-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number1611842151
License Number StateTX

VIII. Authorized Official

Name: SUZIE ROY
Title or Position: MANAGER
Credential:
Phone: 305-378-2381