Individual
STEPHEN W MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 N MISSOURI AVENUE, ROSWELL, NM 88203-4657
(505) 623-8420
Mailing address
101 N MISSOURI AVENUE, ROSWELL, NM 88203-4657
(505) 623-8420
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
79230
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM001943
BCBS
NM
05
—
11189
—
NM
Enumeration date
02/28/2007
Last updated
07/08/2007
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