Provider Demographics
NPI:1922452689
Name:MONTGOMERY, ANNE GASTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:GASTON
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 E APPLEBY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3160
Mailing Address - Country:US
Mailing Address - Phone:479-404-1230
Mailing Address - Fax:479-404-1231
Practice Address - Street 1:3 E APPLEBY RD STE 301
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3160
Practice Address - Country:US
Practice Address - Phone:479-404-1230
Practice Address - Fax:479-404-1231
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA155747207R00000X
ARE15230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine