Healthcare Provider Details

I. General information

NPI: 1205870383
Provider Name (Legal Business Name): KRISTOPHER GEORGE MONTGOMERY OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 HILLCREST DR
SHERMAN TX
75092-5507
US

IV. Provider business mailing address

1216 HILLCREST DR
SHERMAN TX
75092-5507
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7457
  • Fax: 903-893-6671
Mailing address:
  • Phone: 903-893-7457
  • Fax: 903-893-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number108869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: