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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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