Provider Demographics
NPI:1720041767
Name:COX, MONTGOMERY H (MD)
Entity Type:Individual
Prefix:DR
First Name:MONTGOMERY
Middle Name:H
Last Name:COX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-2011
Mailing Address - Fax:
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-327-9178
Practice Address - Fax:828-304-0202
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300327208600000X, 2086X0206X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH394AMedicare PIN
NC2105668OtherMAMSI
NCC6061OtherMEDCOST
NC891330WMedicaid
NC5660363OtherFIRST HEALTH
NC803108OtherPARTNERS
NC1330WOtherBLUE CROSS BLUE SHIELD NC
NCH01150Medicare UPIN
NC2014605Medicare ID - Type Unspecified