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General NPI Number Information
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NPI Number | 1427188242
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Entity Type | Individual
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Provider Name | DAVID GROOM BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 8568 DEL WEBB BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89134
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Country | US
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Telephone | 702-557-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 8586 DEL WEBB BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89134
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Country | US
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Telephone | 702-557-1203
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Fax | 503-233-2889
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | HAS-P-1010102
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License Number State | OR
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