Individual
TERRY L MONTAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1380 E MEDICAL CENTER DR, ST GEORGE, UT 84790-2123
(435) 688-4000
Mailing address
283 E 930 S, OREM, UT 84058-5001
(801) 225-6246
(801) 225-1525
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
174855-1205
UT
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
174855-1205
UT
2085R0202X
Diagnostic Radiology Physician
11253
NV
2085R0202X
Diagnostic Radiology Physician
Primary
174855-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007775101
IHC
UT
01
—
59284499602001
BLUE CROSS
UT
05
—
870487570004
—
UT
01
—
870487570MD1
EMIA
UT
01
—
907907
DMBA
UT
Enumeration date
07/14/2006
Last updated
08/01/2011
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