Provider Demographics
NPI:1164307534
Name:MONTGOMERY, ALAN BRUCE (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:BRUCE
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 EVERGREEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-1022
Mailing Address - Country:US
Mailing Address - Phone:206-390-2261
Mailing Address - Fax:
Practice Address - Street 1:3455 EVERGREEN POINT RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:WA
Practice Address - Zip Code:98039-1022
Practice Address - Country:US
Practice Address - Phone:206-390-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018342207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease