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Individual

ROGER C MONTGOMERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
325 E. LONGVIEW ST., FAYETTEVILLE, AR 72703
(479) 713-7385
(479) 444-7120
Mailing address
PO BOX 550, LOWELL, AR 72745-0550
(479) 463-7775
(479) 463-7187

Taxonomy

Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
N-8043
AR
207R00000X
Internal Medicine Physician
17227
OK
207R00000X
Internal Medicine Physician
N-8043
AR
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
N-8043
AR
208M00000X
Hospitalist Physician
N-8043
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
117900001
AR
01
54200
AR BC/BS
AR
Enumeration date
06/29/2006
Last updated
07/21/2022
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