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Individual

BLAKE WILLIAM MONTGOMERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1681 W 3860 S STE 106B, WEST VALLEY, UT 84119-6274
(385) 429-0785
Mailing address
1681 W 3860 S STE 106B, WEST VALLEY, UT 84119-6274
(385) 429-0785

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8747490-1206
UT

Other

Enumeration date
07/19/2023
Last updated
07/19/2023
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