Provider Demographics
NPI:1891825337
Name:MONTGOMERY, DEBRA LEA (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LEA
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W I 240 SERVICE RD STE A14
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-8203
Mailing Address - Country:US
Mailing Address - Phone:405-632-1002
Mailing Address - Fax:
Practice Address - Street 1:1500 W I 240 SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-8209
Practice Address - Country:US
Practice Address - Phone:405-632-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23942083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine