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General NPI Number Information
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NPI Number | 1538391255
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Entity Type | Organization
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Legal Business Name | B. L. MONTGOMERY M.D., INC
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 6833 ABBOTTSWOOD DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3058
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Country | US
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Telephone | 310-377-2635
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Fax |
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Provider Business Mailing Address
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Address Line | 6833 ABBOTTSWOOD DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3058
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Country | US
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Telephone | 310-377-2635
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BLAINE LEWIS MONTGOMERY
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Credential | MD
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Telephone | 310-377-2635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | A28710
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License Number State | CA
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