Provider Demographics
NPI:1790275170
Name:PATINO MONTOYA, MIGUEL ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ALEJANDRO
Last Name:PATINO 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 1:2900 N BRAESWOOD BLVD APT 1303
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2368
Mailing Address - Country:US
Mailing Address - Phone:832-503-7728
Mailing Address - Fax:
Practice Address - Street 1:115 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6342
Practice Address - Country:US
Practice Address - Phone:508-383-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine