Healthcare Provider Details

I. General information

NPI: 1336566280
Provider Name (Legal Business Name): MIGUEL MONTOYA MD CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 N SEMORAN BLVD SUITE 203
ORLANDO FL
32807-3350
US

IV. Provider business mailing address

6802 N ARMENIA AVE
TAMPA FL
33604-5776
US

V. Phone/Fax

Practice location:
  • Phone: 407-273-0090
  • Fax: 407-273-0091
Mailing address:
  • Phone: 813-304-2361
  • Fax: 813-304-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 105157
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME 105157
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME 105157
License Number StateFL

VIII. Authorized Official

Name: DR. MIGUEL A MONTOYA
Title or Position: PRESIDENT
Credential: MD
Phone: 813-270-6133