Healthcare Provider Details

I. General information

NPI: 1659399178
Provider Name (Legal Business Name): PAULA BLOUNT MONTGOMERY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 N 12TH AVE
PENSACOLA FL
32504
US

IV. Provider business mailing address

5041 N 12TH AVE
PENSACOLA FL
32504
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-2155
  • Fax: 850-202-0600
Mailing address:
  • Phone: 850-433-2155
  • Fax: 850-202-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME44778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: