Provider Demographics
NPI:1396491155
Name:ALFIERO, JESSE T (PA-C)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:T
Last Name:ALFIERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 6TH AVE SW STE C
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2639
Mailing Address - Country:US
Mailing Address - Phone:406-676-3600
Mailing Address - Fax:406-676-3738
Practice Address - Street 1:126 6TH AVE SW STE C
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2639
Practice Address - Country:US
Practice Address - Phone:406-676-3600
Practice Address - Fax:406-676-3738
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT104705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant