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General NPI Number Information
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NPI Number | 1255998928
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Entity Type | Individual
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Provider Name | JAYSON ALLAN MONTGOMERY
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Gender | Male
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 1408 N 16TH ST
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City | ORANGE
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State | TX
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Zip | 77630-3612
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Country | US
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Telephone | 409-883-0876
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Fax |
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Provider Business Mailing Address
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Address Line | 4903 ENGLE FOREST CIR
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City | HUMBLE
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State | TX
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Zip | 77346-4413
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Country | US
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Telephone | 281-229-4521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 63307
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License Number State | TX
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