Organization
MONTGOMERY OTOLARYNGOLOGY LLP
Active
Organization
MONTGOMERY OTOLARYNGOLOGY LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODGER EGELAND MPH (ADMINISTRATOR)
(334) 834-7221
Entity
Organization
Contact information
Practice address
1722 PINE ST, SUITE 804, MONTGOMERY, AL 36106-1103
(334) 834-7221
Mailing address
1722 PINE ST, SUITE 804, MONTGOMERY, AL 36106-1103
(334) 834-7221
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528801560
—
AL
01
—
D507
MEDICARE PTAN
AL
Enumeration date
08/30/2006
Last updated
04/12/2011
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