Organization
WILLIAM G SELF JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES E MONTGOMERY MD (OWNER/PHYSICIAN)
(303) 426-4810
Entity
Organization
Contact information
Practice address
8403 BRYANT ST, WESTMINSTER, CO 80031-3809
(303) 426-4810
(303) 426-8708
Mailing address
8403 BRYANT ST, WESTMINSTER, CO 80031-3809
(303) 426-4810
(303) 426-8708
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04510095
—
CO
01
—
0971086
AETNA HMO
—
01
—
37801
BLUE CROSS/BLUE SHIELD
—
01
—
490000213
RAILROAD MEDICARE
—
01
—
8163314
AETNA PPO
—
01
—
84078518A000
TRICARE
—
Enumeration date
07/07/2005
Last updated
07/21/2022
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