Provider Demographics
NPI:1467524504
Name:CAZZELL, GREGORY WAYNE (HEARING SPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WAYNE
Last Name:CAZZELL
Suffix:
Gender:M
Credentials:HEARING SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1804
Mailing Address - Country:US
Mailing Address - Phone:417-831-1955
Mailing Address - Fax:
Practice Address - Street 1:1306 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1144
Practice Address - Country:US
Practice Address - Phone:417-889-4327
Practice Address - Fax:417-889-3277
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021974237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist