Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 6695 | MS |
NPI | 1083647770 |
---|---|
Provider Name | Dr. Joseph Thomas Balzli |
First Address | Meridian, MS 39301-4016 |
Second Address | Meridian, MS 39301-4016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00016214 | (05) | MS |
D74332 | (02) | MS |