Individual
JASON MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3750 N BRIARWOOD LN, MUNCIE, IN 47304
(765) 213-6373
Mailing address
3750 N BRIARWOOD LN, MUNCIE, IN 47304
(765) 213-6373
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10000879A
IN
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
3167
CO
Other
Enumeration date
08/05/2006
Last updated
10/20/2021
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