Healthcare Provider Details

I. General information

NPI: 1871128264
Provider Name (Legal Business Name): ERIC MONTGOMERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35TH MEDICAL GROUP UNIT 5024
APO AP
96319-5024
US

IV. Provider business mailing address

PSC 76 BOX 7242
APO AP
96319-0073
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0067842
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: