Organization
ANTHONY WAYNE FAMILY PRACTICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE A MONTGOMERY DO (PRESIDENT)
(419) 897-2270
Entity
Organization
Contact information
Practice address
5757 MONCLOVA RD, STE 24, MAUMEE, OH 43537
(419) 897-2290
(419) 897-2290
Mailing address
5757 MONCLOVA RD, STE 24, MAUMEE, OH 43537
(419) 897-2270
(419) 897-2290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34004231M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000142183
ANTHEM BCBS
OH
01
—
02111
PARAMOUNT HEALTH CARE
OH
01
—
080155060
PALMETTO GBA RAILROAD MED
OH
05
—
0904927
—
OH
01
—
236966123
TRICARE
OH
01
—
236966123010
MEDICAL MUTUAL OF OHIO
OH
Enumeration date
11/21/2005
Last updated
07/29/2013
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