Provider Demographics
NPI:1104292077
Name:PRICE, GARY
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 PALM COAST PKWY SW
Mailing Address - Street 2:#1
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4779
Mailing Address - Country:US
Mailing Address - Phone:386-246-6260
Mailing Address - Fax:386-246-6353
Practice Address - Street 1:377 PALM COAST PKWY SW
Practice Address - Street 2:#1
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4779
Practice Address - Country:US
Practice Address - Phone:386-246-6260
Practice Address - Fax:386-246-6353
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2791237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist