MEDICARE: GARY VAN ARMAN

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	1041C0700X	Clinical Social Worker	SW16800	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z2511	OTHER	FL	BLUECROSS

General Provider Information

NPI Number	:	1700847159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY VAN ARMAN

Provider Business Mailing Address
First Line	:	4090 12TH PL SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-4837
Country	:	US
Telephone Number	:	772-569-8908
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 21ST ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3490
Country	:	US
Telephone Number	:	772-569-8908
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	01/28/2009

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