Healthcare Provider Details

I. General information

NPI: 1114900164
Provider Name (Legal Business Name): WILLIAM K MONTGOMERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 W PLANO PKWY
PLANO TX
75093-5005
US

IV. Provider business mailing address

5228 W. PLANO PARKWAY
PLANO TX
75093
US

V. Phone/Fax

Practice location:
  • Phone: 972-250-5700
  • Fax:
Mailing address:
  • Phone: 972-250-5700
  • Fax: 972-250-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberH6447
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberH6447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: