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Individual
DOUGLAS J MONTGOMERY
Active
Individual
DOUGLAS J MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50.000196
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077329
MEDICAID
OH
01
—
1630393
GATEWAY HEALTH
OH
01
—
272352575063
CARESOURCE
OH
01
—
5188071
AETNA
OH
01
—
752112
WELLCARE
OH
01
—
791940
ANTHEM
OH
01
—
H155980
MEDICARE
OH
01
—
K052931
MEDICARE
KY
01
—
P01191326
RAILROAD MEDICARE
OH
01
—
P01252598
RAILROAD MEDICARE
KY
01
—
P10000897204
BUCKEYE
OH
Enumeration date
02/12/2007
Last updated
09/22/2017
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