Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G72529 | CA |
NPI | 1033139266 |
---|---|
Provider Name | William John Montgomery |
First Address | Redlands, CA 92375-1720 |
Second Address | Colton, CA 92324-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 13/07/2007 |