Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | F9843 | TX |
NPI | 1134107261 |
---|---|
Provider Name | Dr. John Montgomery |
First Address | Wichita Falls, TX 76302-2302 |
Second Address | Wichita Falls, TX 76302-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0390494-01 | (05) | TX |
C19487 | (02) | TX |