Individual
MR. ALFRED MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4411 MEDICAL DR STE 300, SAN ANTONIO, TX 78229-3824
(210) 614-5400
(210) 614-2413
Mailing address
4411 MEDICAL DR, SUITE 300, SAN ANTONIO, TX 78229-3822
(210) 614-5400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330839702
—
TX
01
—
386518YR99
MEDICARE
TX
01
—
8629NM
BCBS
TX
01
—
P015229911
RR MEDICARE
TX
Enumeration date
06/12/2013
Last updated
07/21/2022
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