| Doctor Name: | JASON MONTGOMERY |
| NPI Number: | 1013270792 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | NP-1182A |
| Business Practice Address: | 333 N 18th Ave Suite B4 Pocatello, ID - 83201 |
| Business Phone Number: | 2082322233 |
| Business Fax Number: | 2082322299 |
| Mailing Address: | 333 N 18th Ave, Suite B4 POCATELLO |
| State: | ID |
| Postal Code: | 83201 |
| Phone Number: | 2082322233 |
| Fax Number: | 2082322299 |
| NPI Enumeration Date: | 06/19/2012 |
| NPI Last Update Date: | 03/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP-1182A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |