MEDICARE: DR. MARICA MONTGOMERY DVM

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	174M00000X	Veterinarian	12132	TX

General Provider Information

NPI Number	:	1700212933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARICA MONTGOMERY DVM

Provider Business Mailing Address
First Line	:	6611 CYPRESS LAKE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1605
Country	:	US
Telephone Number	:	210-661-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 N LOOP 1604 W
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2897
Country	:	US
Telephone Number	:	210-691-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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