Healthcare Provider Details

I. General information

NPI: 1972723682
Provider Name (Legal Business Name): JEWEL D MONTGOMERY SMAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEWEL DANIELLE MONTGOMERY MD

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

8007 S GALVESTON CT
TULSA OK
74132-2859
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2294
  • Fax:
Mailing address:
  • Phone: 312-480-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number76483
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-17436
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberE-17436
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036126055
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number29202
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: