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Individual

DR. VERNON P MONTOYA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
289 SW STONEGATE TERR, SUITE #103, LAKE CITY, FL 32024-3457
(386) 755-1655
(386) 755-2330
Mailing address
PO BOX 1642, LAKE CITY, FL 32056-1642
(386) 755-1655
(386) 755-2330

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
ME61981
FL
207RX0202X
Medical Oncology Physician
Primary
ME61981
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14993
BCBS
FL
05
370445900
FL
01
K9539
MEDICARE GROUP
FL
01
PTAN 14993U
LINKED TO GROUP PTAN IE881A EFFECTIVE 07/01/15
FL
Enumeration date
11/04/2005
Last updated
03/16/2023
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