Doctor Name: | TERRENCE J MONTGOMERY |
NPI Number: | 1053528760 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | AP2648 |
Business Practice Address: | 61 Bell Rock Plz Sedona, AZ - 863518810 |
Business Phone Number: | 9282044999 |
Business Fax Number: | |
Mailing Address: | Po Box 21540, SEDONA |
State: | AZ |
Postal Code: | 863411540 |
Phone Number: | 9282044999 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2007 |
NPI Last Update Date: | 04/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP2648 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |