Individual
ROBERT MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2861 MADISON AVE, GRANITE CITY, IL 62040-3614
(618) 709-7723
Mailing address
4221 HIGHWAY KK, NEW HAVEN, MO 63068-2146
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2017010802
MO
Other
Enumeration date
05/19/2017
Last updated
10/17/2018
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