Healthcare Provider Details

I. General information

NPI: 1134107261
Provider Name (Legal Business Name): JOHN MONTGOMERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MIDWESTERN PKWY E
WICHITA FALLS TX
76302-2302
US

IV. Provider business mailing address

501 MIDWESTERN PKWY E
WICHITA FALLS TX
76302-2302
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-3551
  • Fax: 940-763-7817
Mailing address:
  • Phone: 940-766-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberF9843
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: