Provider Demographics
NPI:1922395656
Name:MONTGOMERY, DANIEL LEE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
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 1:502 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1400
Mailing Address - Country:US
Mailing Address - Phone:602-501-0187
Mailing Address - Fax:605-719-4012
Practice Address - Street 1:502 E MONROE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1400
Practice Address - Country:US
Practice Address - Phone:605-719-4060
Practice Address - Fax:605-719-4012
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ50465207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program