Provider Demographics
NPI:1215119953
Name:MONTGOMERY, JASON T (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 8476
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8476
Mailing Address - Country:US
Mailing Address - Phone:801-542-8222
Mailing Address - Fax:801-542-8227
Practice Address - Street 1:476 N 900 W
Practice Address - Street 2:SUITE C
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-5199
Practice Address - Country:US
Practice Address - Phone:801-492-1611
Practice Address - Fax:801-492-1480
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6743553-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical