Individual
EARL W MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 S CHURCH ST, SUITE 302, JONESBORO, AR 72401-4176
(870) 935-3990
(870) 935-0871
Mailing address
800 S CHURCH ST, SUITE 302, JONESBORO, AR 72401-4176
(870) 935-3990
(870) 935-0871
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
R3394
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101845001
—
AR
01
—
12876000040
QUALCHOICE
AR
01
—
160028809
MEDICARE RAILROAD CARRIER
AR
01
—
404882
CIGNA
—
01
—
53738
B;UE CROSS
AR
01
—
770138401
EDS BREASTCARE
AR
01
—
AS00140097
HUMANA TRICARE
—
Enumeration date
01/26/2006
Last updated
09/12/2012
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