Provider Demographics
NPI:1760247902
Name:MADDY, JEAN LOUISE (DVM)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:LOUISE
Last Name:MADDY
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 S VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-5149
Mailing Address - Country:US
Mailing Address - Phone:307-237-8387
Mailing Address - Fax:307-237-6677
Practice Address - Street 1:4700 S VALLEY RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-5149
Practice Address - Country:US
Practice Address - Phone:307-237-8387
Practice Address - Fax:307-237-8387
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1891208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice