Basic Information
| Provider Information | |||||||||
| NPI: | 1982892550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERNON MONTOYA MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 SW STATE ROAD 47 | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320250453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867587822 | ||||||||
| FaxNumber: | 3867587789 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 SW STATE ROAD 47 | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320250453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867587822 | ||||||||
| FaxNumber: | 3867587789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | MONTOYA | ||||||||
| AuthorizedOfficialFirstName: | VERNON | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3867587822 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.