# KENNETH DALE MONTGOMERY

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

## Provider details

- **NPI number:** 1922042720
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 188735-1 | NY | Yes |
| 207X00000X | Orthopaedic Surgery Physician | 25MA08100000 | NJ | — |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 01/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 188735-1 | NEW YORK LICENSE | NY |
| 01 | — | 25MA08100000 | NEW JERSEY LICENSE | NJ |