Healthcare Provider Details

I. General information

NPI: 1033717160
Provider Name (Legal Business Name): KDR HEARING TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S SECOND ST
GALLUP NM
87301-6219
US

IV. Provider business mailing address

6115 DOWNEY ST NE
ALBUQUERQUE NM
87109-2633
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-2997
  • Fax:
Mailing address:
  • Phone: 55-263-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: KEITH ROHR
Title or Position: OWNER/ HEARING SPECIALIST
Credential: HEARING AID DISPENSE
Phone: 505-263-2997