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Individual
MEL GRANT
Active
Individual
MEL GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AU.D.
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY151
FL
237600000X
Audiologist-Hearing Aid Fitter
AY 151
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085230900
—
FL
05
—
600037100
—
FL
01
—
640001185
RAILROAD MEDICARE
FL
01
—
J0372
BCBS
FL
01
—
S0526
BCBS
FL
01
—
T0938
BCBS GROUP
FL
Enumeration date
05/27/2005
Last updated
12/05/2014
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