Individual
LARRY LEE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8342 PERKINS RD, SUITE M, BATON ROUGE, LA 70810-1084
(225) 218-4044
(225) 308-4309
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
16277
MS
207Q00000X
Family Medicine Physician
Primary
MD.202410
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120513
—
MS
05
—
1375063
—
LA
01
—
16277
STATE MEDICAL LICENSE
MS
01
—
4N865DX98
MEDICARE MEMBER PTAN
LA
01
—
CDS.036229-MD
STATE BOARD OF PHARMACY
LA
01
—
MD.202410
STATE LICENSE
LA
Enumeration date
07/20/2006
Last updated
03/07/2023
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