MEDICARE: MIGUEL MONTOYA MD CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME 105157	FL
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	ME 105157	FL
3	207R00000X	Internal Medicine Physician	ME 105157	FL

General Provider Information

NPI Number	:	1336566280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGUEL MONTOYA MD CLINIC PA

Provider Business Mailing Address
First Line	:	6802 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5776
Country	:	US
Telephone Number	:	813-304-2361
Fax Number	:	813-304-2362

Provider Business Practice Location Address
First Line	:	672 N SEMORAN BLVD
Second Line	:	SUITE 203
City	:	ORLANDO
State	:	FL
Zip	:	32807-3350
Country	:	US
Telephone Number	:	407-273-0090
Fax Number	:	407-273-0091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIGUEL A MONTOYA
Credential	:	MD
Telephone Number	:	813-270-6133

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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