Provider Demographics
NPI:1508130907
Name:WILLIAMS, GARRY DEAN (LICENSE HEARING AID)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LICENSE HEARING AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4752 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4944
Mailing Address - Country:US
Mailing Address - Phone:727-842-4564
Mailing Address - Fax:727-847-2182
Practice Address - Street 1:4752 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4944
Practice Address - Country:US
Practice Address - Phone:727-842-4564
Practice Address - Fax:727-847-2182
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4289237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist