Provider Demographics
NPI:1235193160
Name:MONTOYA, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-4652
Mailing Address - Fax:916-734-7950
Practice Address - Street 1:2100 POWELL ST
Practice Address - Street 2:SUITE 920
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1826
Practice Address - Country:US
Practice Address - Phone:510-350-2673
Practice Address - Fax:510-597-9200
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27182207P00000X
CAA94685207P00000X
NC2004-01100207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC271823Medicaid
CA00A946850Medicaid
SCP00223202OtherRAILROAD
CAP00455070OtherRAILROAD MEDICARE
SC271823Medicaid
SCI16631Medicare UPIN
SCAA06317283Medicare ID - Type Unspecified