Individual
MR. JEFFREY JAMES MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-3367
Mailing address
PO BOX 27128, ATTN: CREDENTIALING, SALT LAKE CITY, UT 84127-0128
(801) 357-3367
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8401684-1206
UT
363A00000X
Physician Assistant
PA19180
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8401684-1206
UT STATE LICENSE
UT
01
—
PA19180
MEDICAL LICENSE
CA
Enumeration date
07/18/2007
Last updated
11/19/2025
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