Organization
JACK MONCRIEF GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK WESLY MONCRIEF MD (OWNER)
(512) 485-7870
Entity
Organization
Contact information
Practice address
800 WEST 34TH STREET, SUITE 101, AUSTIN, TX 78705
(512) 485-7870
(512) 485-7876
Mailing address
800 WEST 34TH STREET, SUITE 101, AUSTIN, TX 78705
(512) 485-7870
(512) 485-7876
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1311987-04
—
TX
Enumeration date
11/24/2009
Last updated
11/24/2009
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