Provider Demographics
NPI:1992872683
Name:MONTGOMERY RHEUMATOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:MONTGOMERY RHEUMATOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:JAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-284-3105
Mailing Address - Street 1:1421 NARROW LANE PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2654
Mailing Address - Country:US
Mailing Address - Phone:334-284-3105
Mailing Address - Fax:334-284-3107
Practice Address - Street 1:1421 NARROW LANE PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2654
Practice Address - Country:US
Practice Address - Phone:334-284-3105
Practice Address - Fax:334-284-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7797207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10520Medicare ID - Type Unspecified
ALD901Medicare ID - Type Unspecified
ALC73321Medicare UPIN
ALC78859Medicare UPIN
AL14301Medicare ID - Type Unspecified