# DOUGLAS J MONTGOMERY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1437291226
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 50.000196 | OH | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 09/22/2017

## 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 |