MEDICARE: MR. EDGAR MENFUG MOCK

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	237700000X	Hearing Instrument Specialist	3110	FL

General Provider Information

NPI Number	:	1407942154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDGAR MENFUG MOCK

Provider Business Mailing Address
First Line	:	2014 NE 164TH STREET
Second Line	:
City	:	NO MIAMI BEACH
State	:	FL
Zip	:	33162
Country	:	US
Telephone Number	:	305-940-6714
Fax Number	:	305-940-9514

Provider Business Practice Location Address
First Line	:	2014 NE 164TH STREET
Second Line	:
City	:	NO MIAMI BEACH
State	:	FL
Zip	:	33162
Country	:	US
Telephone Number	:	305-940-6714
Fax Number	:	305-940-9514

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/09/2007

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