MEDICARE: DAVID LARRY VALLERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	078994	IA

General Provider Information

NPI Number	:	1407211998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LARRY VALLERY

Provider Business Mailing Address
First Line	:	927 RIDERS CLUB RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-2041
Country	:	US
Telephone Number	:	608-783-7399
Fax Number	:	608-783-7398

Provider Business Practice Location Address
First Line	:	202 1ST ST SE
Second Line	:	SUITE 209
City	:	MASON CITY
State	:	IA
Zip	:	50401-3946
Country	:	US
Telephone Number	:	641-423-1778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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