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General NPI Number Information
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NPI Number | 1952435786
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Entity Type | Individual
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Provider Name | EDWARD JAMES DENEAU BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 930 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547
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Country | US
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Telephone | 850-374-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1772 SEA LARK LN
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City | NAVARRE
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State | FL
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Zip | 32566-7472
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Country | US
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Telephone | 850-816-9742
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Fax |
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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 | 3501003129
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AS5539
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License Number State | FL
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