Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 135000730 | IL |
Y | 213E00000X | Podiatrist | 016005559 | IL |
Y | 222Z00000X | Podiatrist | 016005559 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016005559 | IL |
NPI | 1275829954 |
---|---|
Provider Name | Dr. Raymond R Montoya II |
First Address | Chicago, IL 60611-3370 |
Second Address | Chicago, IL 60611-3370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 01/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
364322013 | (05) | IL |