Provider Demographics
NPI:1679112866
Name:MONTRE, JEFFREY G
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:MONTRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1835
Mailing Address - Country:US
Mailing Address - Phone:785-844-0078
Mailing Address - Fax:785-456-9520
Practice Address - Street 1:400 6TH ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1835
Practice Address - Country:US
Practice Address - Phone:785-844-0078
Practice Address - Fax:785-456-9520
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage