Provider Demographics
NPI:1528323748
Name:F. RENEE MONTGOMERY, MD, PA
Entity type:Organization
Organization Name:F. RENEE MONTGOMERY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:F.
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-992-2905
Mailing Address - Street 1:2233 GOFF DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7742
Mailing Address - Country:US
Mailing Address - Phone:501-992-2905
Mailing Address - Fax:
Practice Address - Street 1:2402 WILDWOOD AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5084
Practice Address - Country:US
Practice Address - Phone:501-992-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7952207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty