Provider Demographics
NPI:1841239266
Name:ALTOM, AUGUST
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:
Last Name:ALTOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3706
Mailing Address - Country:US
Mailing Address - Phone:888-333-9152
Mailing Address - Fax:763-268-4240
Practice Address - Street 1:10601 US HIGHWAY 441
Practice Address - Street 2:E1
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7237
Practice Address - Country:US
Practice Address - Phone:352-315-8400
Practice Address - Fax:352-315-8488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2800237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ8027OtherGROUP ID NUMBER