Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 29520 | MS |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 29520 | MS |
NPI | 1174286579 |
---|---|
Provider Name | Dr. Spencer Montgomery |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 31/01/2022 |