Provider Demographics
NPI:1740220987
Name:KOONZ, JOHN HAROLD (AUD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:KOONZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 MICCOSUKEE COMMONS DR
Mailing Address - Street 2:STE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5490
Mailing Address - Country:US
Mailing Address - Phone:850-553-4327
Mailing Address - Fax:850-877-3084
Practice Address - Street 1:1818 MICCOSUKEE COMMONS DR
Practice Address - Street 2:STE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5490
Practice Address - Country:US
Practice Address - Phone:850-553-4327
Practice Address - Fax:850-877-3084
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1237237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2680OtherBCBS
FL6004172 00Medicaid
FLQ11213Medicare UPIN
FL6004172 00Medicaid