Basic Information
| Provider Information | |||||||||
| NPI: | 1215119953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8476 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049158476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015428222 | ||||||||
| FaxNumber: | 8015428227 | ||||||||
| Practice Location | |||||||||
| Address1: | 476 N 900 W | ||||||||
| Address2: | SUITE C | ||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840035199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014921611 | ||||||||
| FaxNumber: | 8014921480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 6743553-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.