# MR. ALFRED MONTGOMERY

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

## Provider details

- **NPI number:** 1467890442
- **Gender:** Man
- **Credential:** P.A.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |

## Other

- **Enumeration date:** 06/12/2013
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 330839702 | — | TX |
| 01 | — | 386518YR99 | MEDICARE | TX |
| 01 | — | 8629NM | BCBS | TX |
| 01 | — | P015229911 | RR MEDICARE | TX |