Individual
ROBERT MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
14898
MN
363A00000X
Physician Assistant
4811
WI
363AS0400X
Surgical Physician Assistant
Primary
4811-23
WI
Other
Enumeration date
07/18/2019
Last updated
08/25/2025
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