MEDICARE: DR. RICHARD S. MONTGOMERY 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	2085R0202X	Diagnostic Radiology Physician	N8226	TX
2	2085R0202X	Diagnostic Radiology Physician	C142575	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821273038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD S. MONTGOMERY MD

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1204
Country	:	US
Telephone Number	:	619-532-8670
Fax Number	:

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1204
Country	:	US
Telephone Number	:	619-532-8670
Fax Number	:

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	08/12/2016

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