Provider Demographics
NPI:1609040427
Name:MONTGOMERY, JOANNE RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:RUTH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANNE
Other - Middle Name:RUTH
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:567 32ND AVE E STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8480
Mailing Address - Country:US
Mailing Address - Phone:701-941-3100
Mailing Address - Fax:701-941-3301
Practice Address - Street 1:567 32ND AVE E STE 100
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8480
Practice Address - Country:US
Practice Address - Phone:701-941-3100
Practice Address - Fax:701-941-3301
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109271207N00000X
MN60088207N00000X
ND14005207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology