Provider Demographics
NPI:1033204763
Name:MONTGOMERY, DEAN PARKER JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:PARKER
Last Name:MONTGOMERY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 471556
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74147-1556
Mailing Address - Country:US
Mailing Address - Phone:918-250-6805
Mailing Address - Fax:918-250-2084
Practice Address - Street 1:100 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5007
Practice Address - Country:US
Practice Address - Phone:918-758-1910
Practice Address - Fax:918-756-1270
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100840530AMedicaid
OK731229233002OtherBLUE CROSS BLUE SHIELD