Healthcare Provider Details

I. General information

NPI: 1659834216
Provider Name (Legal Business Name): ETHAN CLUFF HEARING AID DISPENSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 E MCKELLIPS RD STE 4-225
SCOTTSDALE AZ
85257-4600
US

IV. Provider business mailing address

14050 N 83RD AVE STE 290
PEORIA AZ
85381-5650
US

V. Phone/Fax

Practice location:
  • Phone: 888-495-4489
  • Fax: 602-865-8090
Mailing address:
  • Phone: 480-687-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: