Healthcare Provider Details

I. General information

NPI: 1669585915
Provider Name (Legal Business Name): LARA ROYSTER GRAY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 S BECKFORD DR SUITE H
HENDERSON NC
27536-3486
US

IV. Provider business mailing address

857 S BECKFORD DR SUITE H
HENDERSON NC
27536-3486
US

V. Phone/Fax

Practice location:
  • Phone: 252-430-7744
  • Fax: 252-430-0917
Mailing address:
  • Phone: 252-430-7744
  • Fax: 252-430-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4578
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: