Provider Demographics
NPI:1780851261
Name:MONTGOMERY, FRED ADAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:ADAMS
Last Name:MONTGOMERY
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 1:215 S 11TH AVE
Mailing Address - Street 2:D
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3255
Mailing Address - Country:US
Mailing Address - Phone:509-248-6192
Mailing Address - Fax:509-452-5433
Practice Address - Street 1:215 S 11TH AVE
Practice Address - Street 2:D
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3255
Practice Address - Country:US
Practice Address - Phone:509-248-6192
Practice Address - Fax:509-452-5433
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000095122084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry