Healthcare Provider Details

I. General information

NPI: 1992798680
Provider Name (Legal Business Name): MIGUEL A MONTOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 W VIRGINIA AVE
TAMPA FL
33607-6310
US

IV. Provider business mailing address

2511 W VIRGINIA AVE
TAMPA FL
33607-6310
US

V. Phone/Fax

Practice location:
  • Phone: 813-270-6133
  • Fax: 813-350-0053
Mailing address:
  • Phone: 813-270-6133
  • Fax: 813-350-0053

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:
Title or Position:
Credential:
Phone: