Provider Demographics
NPI:1215374160
Name:MONTOYA, JUAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:DAVID
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N CHURCH ST UNIT 1314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2266
Mailing Address - Country:US
Mailing Address - Phone:954-802-8095
Mailing Address - Fax:
Practice Address - Street 1:811 MEADOW SCAPE
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1654
Practice Address - Country:US
Practice Address - Phone:954-802-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6023207P00000X
NC2015-01507207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty