Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 28450 | KY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 6084 | PR |
NPI | 1225465461 |
---|---|
Provider Name | Victor M Montes Jordan |
First Address | Viera, FL 32940-2200 |
Second Address | Viera, FL 32940-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2013 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6084 | LICENSE (01) | PR |
C78181 | (02) | KY |