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NPI Code Detail

MEDICARE: JOHN GONZALES IV H.I.S.

MEDICARE: JOHN GONZALES IV H.I.S.
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
1237700000XHearing Instrument Specialist2010035283MO

General Provider Information

NPI Number : 1578861712
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN GONZALES IV H.I.S.
Provider Business Mailing Address
First Line : 4307 FAIR HAVEN DR
Second Line :
City : NIXA
State : MO
Zip : 65714-7339
Country : US
Telephone Number : 417-631-2522
Fax Number :
Provider Business Practice Location Address
First Line : 1902 W 19TH ST
Second Line : SUITE A
City : MOUNTAIN GROVE
State : MO
Zip : 65711-1287
Country : US
Telephone Number : 417-631-2522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2011
Last Update Date : 03/07/2014

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