Individual
BRUCE A MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5757 MONCLOVA RD, STE 24, MAUMEE, OH 43537-1863
(419) 897-2270
(419) 897-2290
Mailing address
5757 MONCLOVA RD, STE 24, MAUMEE, OH 43537-1863
(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
Enumeration date
11/21/2005
Last updated
05/02/2011
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