Healthcare Provider Details

I. General information

NPI: 1508057696
Provider Name (Legal Business Name): THOMAS J. MONTGOMERY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 HEYMANN BLVD
LAFAYETTE LA
70503-2616
US

IV. Provider business mailing address

449 HEYMANN BLVD
LAFAYETTE LA
70503-2616
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-2264
  • Fax: 337-232-4426
Mailing address:
  • Phone: 337-235-2264
  • Fax: 337-232-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number020154
License Number StateLA

VIII. Authorized Official

Name: DR. THOMAS JOSEPH MONTGOMERY
Title or Position: OWNER
Credential: M.D.
Phone: 337-235-2264