Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R3G58 | MO |
Y | 2080P0202X | Pediatric Cardiologist | R3G58 | MO |
N | 2086S0120X | Pediatric Surgery | R3G58 | MO |
NPI | 1134147572 |
---|---|
Provider Name | Dr. David T Balzer |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207653205 | (05) | MO |