MEDICARE: BRUCE MONTGOMERIE MD

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	208000000X	Pediatrics Physician	1846081205	UT

General Provider Information

NPI Number	:	1780615153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE MONTGOMERIE MD

Provider Business Mailing Address
First Line	:	3725 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5411
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:	801-965-3526

Provider Business Practice Location Address
First Line	:	3725 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5411
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:	801-965-3526

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/27/2021

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