Individual
DR. CHARLES MONTGOMERY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
(865) 541-2787
Mailing address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
26340
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050083450
TRAVELERS MEDICARE
TN
01
—
100021855
PHP TENNCARE
TN
05
—
3099461
—
TN
01
—
4020734
BLUE CROSS
TN
Enumeration date
03/09/2006
Last updated
06/16/2010
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