Provider Demographics
NPI:1588607626
Name:MONTOYA, JUAN DIEGO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DIEGO
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 1:850 E HARVARD AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5076
Mailing Address - Country:US
Mailing Address - Phone:303-825-8822
Mailing Address - Fax:303-825-4022
Practice Address - Street 1:850 E HARVARD AVE STE 305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5076
Practice Address - Country:US
Practice Address - Phone:303-825-8822
Practice Address - Fax:303-825-4022
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.39498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27929027Medicaid
COG17479Medicare UPIN
COC805801Medicare PIN