Healthcare Provider Details

I. General information

NPI: 1235524455
Provider Name (Legal Business Name): EDWARD GAVRONSKI A.T.,H.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 S STEELE ST STE 100
TACOMA WA
98409-7226
US

IV. Provider business mailing address

12211 EDGEWOOD AVE SW APT 6
LAKEWOOD WA
98498-1289
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-5587
  • Fax: 253-475-5597
Mailing address:
  • Phone: 253-579-8617
  • Fax: 253-475-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number60371050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: