Montgomery, Bruce A

Montgomery, Bruce A is an sole proprietor health care provider with primary practice located at 5757 Monclova Rd Ste 24, Maumee OH 43537-1863. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Montgomery, Bruce A can be contacted via phone (419) 897-2270.

Contact Information

Primary practice address
5757 Monclova Rd Ste 24 Maumee OH 43537-1863
Phone: (419) 897-2270
Fax: (419) 897-2290
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 34004231M Ohio

Profile Details

NPI number 1689657934
LBN Legal business name Montgomery, Bruce A
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 21st, 2005
Last updated May 2nd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689657934 NPPES
Ohio Other 000000142183 ANTHEM BCBS
Ohio Other 02111 ANTHEM BCBS
Ohio MEDICAID 0904927 ANTHEM BCBS
Ohio Other 080155060 ANTHEM BCBS

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