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NPI Code Detail

MEDICARE: DR. JACK WESLY MONCRIEF M.D.

MEDICARE: DR. JACK WESLY MONCRIEF M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology PhysicianD-0234TX

General Provider Information

NPI Number : 1164439295
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK WESLY MONCRIEF M.D.
Provider Business Mailing Address
First Line : 800 W 34TH ST
Second Line : 100
City : AUSTIN
State : TX
Zip : 78705-1143
Country : US
Telephone Number : 512-485-7870
Fax Number : 512-494-4042
Provider Business Practice Location Address
First Line : 800 W 34TH ST
Second Line : 100
City : AUSTIN
State : TX
Zip : 78705-1143
Country : US
Telephone Number : 512-485-7870
Fax Number : 512-494-4042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 08/25/2016

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