Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A89930 | CA |
N | 2080P0202X | Pediatric Cardiologist | A89930 | CA |
NPI | 1093901639 |
---|---|
Provider Name | Douglas Allen Balster |
First Address | Palo Alto, CA 94304-2203 |
Second Address | Palo Alto, CA 94304-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 15/12/2021 |