Provider Demographics
NPI:1861441388
Name:SELLON, MONTY ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:MONTY
Middle Name:ROY
Last Name:SELLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 W 23RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2592
Mailing Address - Country:US
Mailing Address - Phone:402-721-5727
Mailing Address - Fax:402-753-6096
Practice Address - Street 1:350 W 23RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2592
Practice Address - Country:US
Practice Address - Phone:402-721-5727
Practice Address - Fax:402-753-6096
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE17703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073727000Medicaid
NEE46511Medicare UPIN
NE47073727000Medicaid