MEDICARE: MR. GERSON DAVID BARAHONA

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	10723	TX
2	237700000X	Hearing Instrument Specialist	80342	TX

General Provider Information

NPI Number	:	1831356013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERSON DAVID BARAHONA

Provider Business Mailing Address
First Line	:	5843 PALMETTO WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5664
Country	:	US
Telephone Number	:	210-544-2500
Fax Number	:	210-688-6119

Provider Business Practice Location Address
First Line	:	5843 PALMETTO WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5664
Country	:	US
Telephone Number	:	210-544-2500
Fax Number	:	210-688-6119

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	09/21/2011

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