MEDICARE: STEPHEN W MONTGOMERY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	79230	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00NM001943	OTHER	NM	BCBS

General Provider Information

NPI Number	:	1760519227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN W MONTGOMERY MD

Provider Business Mailing Address
First Line	:	101 N MISSOURI AVENUE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-4657
Country	:	US
Telephone Number	:	505-623-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N MISSOURI AVENUE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-4657
Country	:	US
Telephone Number	:	505-623-8420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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