Provider Demographics
NPI:1043508872
Name:MONTAGUE, GLENDA LOIS (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LOIS
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2909
Mailing Address - Country:US
Mailing Address - Phone:707-251-3608
Mailing Address - Fax:707-251-1727
Practice Address - Street 1:1100 TRANCAS ST STE 210
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2909
Practice Address - Country:US
Practice Address - Phone:707-251-3608
Practice Address - Fax:707-251-1727
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060100207YX0602X
CAA142034207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy