Basic Information
| Provider Information | |||||||||
| NPI: | 1740220987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOONZ | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 MICCOSUKEE COMMONS DR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505534327 | ||||||||
| FaxNumber: | 8508773084 | ||||||||
| Practice Location | |||||||||
| Address1: | 1818 MICCOSUKEE COMMONS DR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505534327 | ||||||||
| FaxNumber: | 8508773084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | AY1237 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | S2680 | 01 | FL | BCBS | OTHER | 6004172 00 | 05 | FL | MEDICAID |