Provider Demographics
NPI:1306208020
Name:MONTEMAYOR, JON DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DANIEL
Last Name:MONTEMAYOR
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 1:5400 FRANTZ RD STE 250
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-533-6497
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:697 THOMAS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3931
Practice Address - Country:US
Practice Address - Phone:614-566-2426
Practice Address - Fax:614-533-0433
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.133707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program