Provider Demographics
NPI:1598852857
Name:VIDES DE MONTOYA, JOAQUINA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUINA
Middle Name:ELIZABETH
Last Name:VIDES DE MONTOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-1656
Mailing Address - Country:US
Mailing Address - Phone:731-772-3442
Mailing Address - Fax:731-772-3662
Practice Address - Street 1:1215 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-1656
Practice Address - Country:US
Practice Address - Phone:731-772-3442
Practice Address - Fax:731-772-3662
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41609173000000X, 207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease