Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DO00633 | RI |
N | 111NI0900X | Internist | DO00633 | RI |
Y | 207RI0200X | Infectious Disease | DR.0055076 | CO |
NPI | 1053330472 |
---|---|
Provider Name | Brian T Montague |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 19/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I62544 | (02) | RI |