Provider Demographics
NPI:1861469603
Name:MONTGOMERY, JAMES C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-0938
Mailing Address - Country:US
Mailing Address - Phone:877-839-9517
Mailing Address - Fax:903-531-2337
Practice Address - Street 1:1245 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7518
Practice Address - Country:US
Practice Address - Phone:817-310-0922
Practice Address - Fax:817-310-0910
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ83192084P0800X
LA0154192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10020730ZMedicaid
TX10020730ZMedicaid
TX00T8ZFMedicare ID - Type Unspecified