Provider Demographics
NPI:1689311474
Name:SELMAN, GREG W (HADE12969)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:W
Last Name:SELMAN
Suffix:
Gender:M
Credentials:HADE12969
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W ESPERANZA BLVD STE 115L
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2626
Mailing Address - Country:US
Mailing Address - Phone:520-393-7978
Mailing Address - Fax:602-393-5589
Practice Address - Street 1:115 W ESPERANZA BLVD STE 115L
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2626
Practice Address - Country:US
Practice Address - Phone:520-393-7978
Practice Address - Fax:602-393-5589
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE12969237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist