MEDICARE: MR. GARY STEVEN DEMAREST JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1093452492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY STEVEN DEMAREST JR.

Provider Business Mailing Address
First Line	:	3001 SW 24TH AVE APT 802
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-7825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 GRANTS LAKE BLVD UNIT 17477
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77496-0869
Country	:	US
Telephone Number	:	281-768-6730
Fax Number	:	281-768-6766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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