Healthcare Provider Details

I. General information

NPI: 1124089321
Provider Name (Legal Business Name): MONTGOMERY L ROBERTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 204
SHAWNEE MISSION KS
66204-2553
US

IV. Provider business mailing address

7450 KESSLER ST STE 204
SHAWNEE MISSION KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9770
  • Fax: 913-632-9799
Mailing address:
  • Phone: 913-632-9770
  • Fax: 913-632-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3987
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number3987
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number3987
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number37355
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: