1144313156 NPI number — DR. DONALD WAYNE MONTGOMERY D.P.M.

Table of content: DR. DONALD WAYNE MONTGOMERY D.P.M. (NPI 1144313156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144313156 NPI number — DR. DONALD WAYNE MONTGOMERY D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
DONALD
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTGOMERY
Provider Other First Name:
DONALD
Provider Other Middle Name:
WAYNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144313156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3520 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77701-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-832-5956
Provider Business Mailing Address Fax Number:
409-832-2671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3520 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77701-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-832-5956
Provider Business Practice Location Address Fax Number:
409-832-2671
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  0869 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 092759201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".