Provider Demographics
NPI:1033142898
Name:MONTGOMERY, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13070 RIVER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4517
Mailing Address - Country:US
Mailing Address - Phone:812-343-1723
Mailing Address - Fax:
Practice Address - Street 1:1159 W JEFFERSON ST STE 304
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-736-5515
Practice Address - Fax:317-738-0198
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01041404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386210Medicaid