Individual
GORDON JAMES MONTGOMERY
Inactive
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
835 THIRD AVE STE A, CHULA VISTA, CA 91911-1352
(619) 425-7755
(619) 425-2138
Mailing address
835 THIRD AVE STE A, CHULA VISTA, CA 91911-1352
(619) 425-7755
(619) 425-2138
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G31591
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G315911
—
CA
05
—
00G5315910
—
CA
01
—
WG31591D
MEDICARE PIN # (R)
CA
Enumeration date
06/23/2005
Last updated
08/26/2020
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