Provider Demographics
NPI:1144217001
Name:MONTGOMERY, JOSEPH SAMUEL III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:MONTGOMERY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5884
Mailing Address - Country:US
Mailing Address - Phone:281-955-5300
Mailing Address - Fax:281-955-8166
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:SUITE 315
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:281-955-5300
Practice Address - Fax:281-955-8166
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE8740207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035682601Medicaid
TXOORB05OtherP-TAN
TXD97570Medicare UPIN