Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 222 | TX |
NPI | 1477798213 |
---|---|
Provider Name | Daniel David Balcom |
First Address | Dallas, TX 75216-7167 |
Second Address | Dallas, TX 75216-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2008 |
Last Update Date | 09/12/2008 |