MEDICARE: MONTGOMERY FAMILY PRACTICE PC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639245707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	1758 PARK PL STE 402
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1135
Country	:	US
Telephone Number	:	334-265-7255
Fax Number	:	334-265-9055

Provider Business Practice Location Address
First Line	:	1758 PARK PL STE 402
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1135
Country	:	US
Telephone Number	:	334-265-7255
Fax Number	:	334-265-9055

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID COFFEY
Credential	:	DO
Telephone Number	:	334-265-7255

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/13/2011

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