Healthcare Provider Details

I. General information

NPI: 1659399939
Provider Name (Legal Business Name): DANIEL MONTOYA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 200
BEND OR
97701-4281
US

IV. Provider business mailing address

2200 NE NEFF RD STE 200
BEND OR
97701-4281
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-3344
  • Fax:
Mailing address:
  • Phone: 541-382-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00707
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: