Individual
TERRY L MONTAGUE
Active
Individual
TERRY L MONTAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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