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General NPI Number Information
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NPI Number | 1316163918
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Entity Type | Organization
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Legal Business Name | GREGORY BROTHERTON
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 819 S STATE HIGHWAY 49
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City | JACKSON
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State | CA
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Zip | 95642-2622
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Country | US
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Telephone | 209-223-2436
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Fax | 209-257-0729
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Provider Business Mailing Address
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Address Line | 819 S STATE HIGHWAY 49
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City | JACKSON
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State | CA
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Zip | 95642-2622
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Country | US
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Telephone | 209-223-2436
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Fax | 209-257-0729
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Authorized Official
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Title or Position | HEARING AID DISPENSER
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Name | GREGORY BROTHERTON
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Credential |
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Telephone | 209-223-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA2805
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License Number State | CA
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