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General NPI Number Information
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NPI Number | 1013107077
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Entity Type | Organization
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Legal Business Name | ID ASSOCIATES OF JACKSONVILLE PA
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 2 SHIRCLIFF WAY STE 610
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4753
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Country | US
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Telephone | 904-387-5027
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Fax | 904-387-2208
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Provider Business Mailing Address
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Address Line | 2 SHIRCLIFF WAY STE 610
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4753
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Country | US
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Telephone | 904-387-5027
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Fax | 904-387-2208
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN-PAUL MONTOYA
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Credential | MD
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Telephone | 904-387-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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