Provider Demographics
NPI:1467781328
Name:ROBERTO MONTOYA M.D., P.A.
Entity Type:Organization
Organization Name:ROBERTO MONTOYA M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-907-4456
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:713-907-4456
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:1810 NANTUCKET DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2912
Practice Address - Country:US
Practice Address - Phone:713-907-4456
Practice Address - Fax:281-833-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4905208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AB79OtherBLUE CROSS BLUE SHIELD
TX10043543OtherAMERIGROUP
TX401073OtherAETNA
TX031816401Medicaid
TX00AB79Medicare PIN