Provider Demographics
NPI:1013114412
Name:ROSONET, GARY MICHAEL (FAAA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:ROSONET
Suffix:
Gender:M
Credentials:FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 PASS RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2739
Mailing Address - Country:US
Mailing Address - Phone:228-385-0361
Mailing Address - Fax:228-385-0363
Practice Address - Street 1:2575 PASS RD
Practice Address - Street 2:SUITE G
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2739
Practice Address - Country:US
Practice Address - Phone:228-385-0361
Practice Address - Fax:228-385-0363
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3039231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist