Active NPI
Earl W Montgomery
- Gynecology Physician
- Jonesboro, AR
National Provider Identifier
1790755098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- R3394
- Practice address
- 800 S Church St
Suite 302
Jonesboro, AR 72401-4176 - Phone
- (870) 935-3990
- Fax
- (870) 935-0871
- NPI assigned
- Jan 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | R3394 | AR | Primary |
Addresses
Primary practice location
800 S Church St
Suite 302
Jonesboro, AR 72401-4176
Mailing address
800 S Church St
Suite 302
Jonesboro, AR 72401-4176
Phone (870) 935-3990
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160028809 | Other | AR | MEDICARE RAILROAD CARRIER |
| 404882 | Other | CIGNA | |
| 101845001 | Medicaid | AR | |
| 53738 | Other | AR | B;UE CROSS |
| 770138401 | Other | AR | EDS BREASTCARE |
| AS00140097 | Other | HUMANA TRICARE | |
| 12876000040 | Other | AR | QUALCHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3394 | AR | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347408000000",
"number": "1790755098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 S CHURCH ST",
"address_2": "SUITE 302",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724014176",
"telephone_number": "870-935-3990",
"fax_number": "870-935-0871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 S CHURCH ST",
"address_2": "SUITE 302",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724014176",
"telephone_number": "870-935-3990",
"fax_number": "870-935-0871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "EARL",
"middle_name": "W",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-26",
"last_updated": "2012-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "AR",
"license": "R3394",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD CARRIER",
"identifier": "160028809",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "404882",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101845001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B;UE CROSS",
"identifier": "53738",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDS BREASTCARE",
"identifier": "770138401",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA TRICARE",
"identifier": "AS00140097",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "12876000040",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.