Provider Demographics
NPI:1922373349
Name:STEPHEN W. MONTGOMERY, MD, PA
Entity Type:Organization
Organization Name:STEPHEN W. MONTGOMERY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILDER
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-623-8420
Mailing Address - Street 1:101 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-4657
Mailing Address - Country:US
Mailing Address - Phone:575-623-8420
Mailing Address - Fax:575-623-8421
Practice Address - Street 1:101 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-4657
Practice Address - Country:US
Practice Address - Phone:575-623-8420
Practice Address - Fax:575-623-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty