Individual
LISA MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3309 S 750 W, RUSSIAVILLE, IN 46979-9146
(765) 883-2273
Mailing address
3309 S 750 W, RUSSIAVILLE, IN 46979-9146
(765) 883-2273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000327
IN
Other
Enumeration date
10/25/2006
Last updated
03/24/2021
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