Provider Demographics
NPI:1245262732
Name:SPIRAKIS, GREGORY J (AUD CCC A)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:SPIRAKIS
Suffix:
Gender:M
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:863-686-3189
Mailing Address - Fax:863-682-1348
Practice Address - Street 1:710 E BELLA VISTA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-686-3189
Practice Address - Fax:863-682-1348
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY345231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11981901OtherCITRUS HEALTHCARE
FL06584OtherHEAR USA
FL115577OtherAMERIGROUP
FL51716OtherBLUE CROSS BLUE SHIELD
FL11981901OtherCITRUS HEALTHCARE