Provider Demographics
NPI:1811901390
Name:MONTOYA, PAUL M (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:MONTOYA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3923
Mailing Address - Country:US
Mailing Address - Phone:904-964-5455
Mailing Address - Fax:904-964-4099
Practice Address - Street 1:345 W MADISON ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3923
Practice Address - Country:US
Practice Address - Phone:904-964-5455
Practice Address - Fax:904-964-4099
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24166207Q00000X
FLME125680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731734Medicaid
FL015967300Medicaid
NE10025238700Medicaid
IA1811901390Medicaid
FL33181OtherBCBS FLORIDA
NE10025464000Medicaid
NE47068731741Medicaid
NE47068731749Medicaid
NE50056OtherBCBS
NE10025464000Medicaid
NE47068731749Medicaid