Healthcare Provider Details

I. General information

NPI: 1740361849
Provider Name (Legal Business Name): EARL JAY REPPERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE SUITE E-110
MANHATTAN KS
66502-2770
US

IV. Provider business mailing address

1133 COLLEGE AVE SUITE E-110
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-537-2651
  • Fax: 785-537-4276
Mailing address:
  • Phone: 785-537-2651
  • Fax: 785-537-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-20073
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: