Healthcare Provider Details

I. General information

NPI: 1457410961
Provider Name (Legal Business Name): FREDERICK A MONTGOMERY MD INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SO 11TH # D
YAKIMA WA
98902
US

IV. Provider business mailing address

215 SO 11TH # D
YAKIMA WA
98902
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-6192
  • Fax: 509-452-5433
Mailing address:
  • Phone: 509-248-6192
  • Fax: 509-452-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00009512
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00009512
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD00009512
License Number StateWA

VIII. Authorized Official

Name: DR. FREDERICK A MONTGOMERY
Title or Position: PRESIDENT
Credential: MD
Phone: 509-248-6192