Provider Demographics
NPI:1396559738
Name:MONCIER, WILFRED TERRY JR
Entity type:Individual
Prefix:
First Name:WILFRED
Middle Name:TERRY
Last Name:MONCIER
Suffix:JR
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 1:931 N WACO ST
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-4433
Mailing Address - Country:US
Mailing Address - Phone:903-821-9989
Mailing Address - Fax:
Practice Address - Street 1:931 N WACO ST
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-4433
Practice Address - Country:US
Practice Address - Phone:903-209-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18031474172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver