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Organization
ROGUE ANESTHESIA LLC
Active
Organization
ROGUE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT A MONTGOMERY III MD (MANAGER)
(541) 472-4884
Entity
Organization
Contact information
Practice address
1601 NW HAWTHORNE AVE, GRANTS PASS, OR 97526
(541) 472-4884
Mailing address
5319 SW WESTGATE DR, 241, PORTLAND, OR 97221-2432
(503) 297-7223
(503) 297-7603
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD18872
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023807000
REGENCE BCBSO
OR
05
—
130351
—
OR
Enumeration date
06/29/2006
Last updated
11/01/2010
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