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NPI Code Detail

MEDICARE: DR. MARK HARLOW MONTGOMERY M.D.

MEDICARE: DR. MARK HARLOW MONTGOMERY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YX0602XOtolaryngic Allergy PhysicianME 84347FL

General Provider Information

NPI Number : 1528012655
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK HARLOW MONTGOMERY M.D.
Provider Business Mailing Address
First Line : 9240 BONITA BEACH RD SE STE 1106
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34135-4250
Country : US
Telephone Number : 239-495-6200
Fax Number : 239-495-6247
Provider Business Practice Location Address
First Line : 9240 BONITA BEACH RD SE STE 1106
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34135-4250
Country : US
Telephone Number : 239-495-6200
Fax Number : 239-495-6247
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 10/25/2023

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