Provider Demographics
NPI:1124224860
Name:PERRY, HARLAN ROGER JR (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:MR
First Name:HARLAN
Middle Name:ROGER
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 DELNERO DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5223
Mailing Address - Country:US
Mailing Address - Phone:209-532-4008
Mailing Address - Fax:209-532-6723
Practice Address - Street 1:782 DELNERO DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5223
Practice Address - Country:US
Practice Address - Phone:209-532-4008
Practice Address - Fax:209-532-6723
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA0016930237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist