Individual
MR. TRAVIS H MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
222 MEDICAL CIR, MOREHEAD, KY 40351-1179
(606) 783-6520
(606) 783-6489
Mailing address
222 MEDICAL CIR, MOREHEAD, KY 40351-1179
(606) 783-6520
(606) 783-6489
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1714
KY
363AM0700X
Medical Physician Assistant
Primary
PA1714
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100216070
—
KY
Enumeration date
02/10/2012
Last updated
03/05/2019
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