Provider Demographics
NPI:1336141837
Name:MONTOYA, STEPHEN KELLY (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KELLY
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 1:9260 W SUNSET RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4858
Mailing Address - Country:US
Mailing Address - Phone:702-255-3547
Mailing Address - Fax:702-921-2419
Practice Address - Street 1:5320 S RAINBOW BLVD
Practice Address - Street 2:STE 182
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1895
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-921-2419
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002635Medicaid
NV100504536Medicaid
NV002002635Medicaid
NVBA909Medicare PIN
NV37628Medicare PIN
NV100504536Medicaid
NVV37628Medicare PIN