Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | H6447 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | H6447 | TX |
NPI | 1114900164 |
---|---|
Provider Name | William K Montgomery |
First Address | Plano, TX 75093 |
Second Address | Plano, TX 75093-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 29/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122324003 | (05) | TX |
8X9500 | BCBS (01) | TX |
G05345 | (02) | TX |