Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2019026178 | MO |
NPI | 1003278532 |
---|---|
Provider Name | Megan Marie Montague |
First Address | Louisville, KY 40202-3818 |
Second Address | West Plains, MO 65775-4221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 11/07/2019 |