Provider Demographics
NPI:1528012655
Name:MONTGOMERY, MARK HARLOW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HARLOW
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9240 BONITA BEACH RD SE STE 1106
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4250
Mailing Address - Country:US
Mailing Address - Phone:239-495-6200
Mailing Address - Fax:239-495-6247
Practice Address - Street 1:9240 BONITA BEACH RD SE STE 1106
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4250
Practice Address - Country:US
Practice Address - Phone:239-495-6200
Practice Address - Fax:239-495-6247
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84347207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51950Medicare ID - Type Unspecified