Basic Information
Provider Information
NPI: 1720041767
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COX
FirstName: MONTGOMERY
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 KIMEL FOREST DR
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271036074
CountryCode: US
TelephoneNumber: 3367162011
FaxNumber:  
Practice Location
Address1: 415 N CENTER ST
Address2: SUITE 102
City: HICKORY
State: NC
PostalCode: 286015036
CountryCode: US
TelephoneNumber: 8283279178
FaxNumber: 8283040202
Other Information
ProviderEnumerationDate: 04/10/2006
LastUpdateDate: 12/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X200300327NCY Allopathic & Osteopathic PhysiciansSurgery 
2086X0206X200300327NCN Allopathic & Osteopathic PhysiciansSurgerySurgical Oncology
2086S0129X200300327NCN Allopathic & Osteopathic PhysiciansSurgeryVascular Surgery

No ID Information.


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