Provider Demographics
NPI:1326379207
Name:BUETTNER, MONTY J
Entity Type:Individual
Prefix:
First Name:MONTY
Middle Name:J
Last Name:BUETTNER
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:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-0172
Mailing Address - Country:US
Mailing Address - Phone:509-427-7379
Mailing Address - Fax:
Practice Address - Street 1:200 VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-6447
Practice Address - Country:US
Practice Address - Phone:509-427-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist