Provider Demographics
NPI:1083625677
Name:MONTGOMERY, JAMES EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDMUND
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10465 MELODY DR
Mailing Address - Street 2:STE 111
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4119
Mailing Address - Country:US
Mailing Address - Phone:303-252-9981
Mailing Address - Fax:303-252-7306
Practice Address - Street 1:10465 MELODY DR
Practice Address - Street 2:STE 111
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4119
Practice Address - Country:US
Practice Address - Phone:303-252-9981
Practice Address - Fax:303-252-7306
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO39792207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84981326Medicaid
911546OtherSECURE HORIZONS
COF69054Medicare UPIN
911546OtherSECURE HORIZONS