Provider Demographics
NPI:1649281395
Name:MONTAGUE, PAUL ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROGER
Last Name:MONTAGUE
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 1:7335 N 1ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2968
Mailing Address - Country:US
Mailing Address - Phone:559-438-2800
Mailing Address - Fax:559-438-1290
Practice Address - Street 1:7335 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2968
Practice Address - Country:US
Practice Address - Phone:559-438-2800
Practice Address - Fax:559-438-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25708ZMedicare ID - Type Unspecified
CAA43178Medicare UPIN