Dr. Larry Dale Balzer
Family Doctor - Geriatric Medicine
105 S Bryant Ave Suite #210
Edmond
, Oklahoma 73034-6399
Dr. Larry Dale Balzer
Family Doctor - Geriatric Medicine
105 S Bryant Ave Suite #210
Edmond
, Oklahoma 73034-6399
(405) 359-5214
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About
Features
Specialties
- Family Doctor - Geriatric Medicine
Languages spoken
- English
Location
First Address
- Dr. Larry Dale Balzer
- 105 S Bryant Suite #210
- Edmond, OK
- Zip : 73034
- Fax : (405) 359-5214
- Phone : (405) 359-5229
Second Address
- Dr. Larry Dale Balzer
- 105 S Bryant Ave Suite #210
- Edmond, OK
- Zip : 73034-6399
- Fax : (405) 359-5214
- Phone : (405) 359-5229
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QG0300X | Family Doctor - Geriatric Medicine | 9795 | OK |
| N | 207QG0300X | Family Doctor - Geriatric Medicine | E1498 | TX |
National Provider Identifier
| NPI | 1235129370 |
|---|---|
| Provider Name | Dr. Larry Dale Balzer |
| First Address | Edmond, OK 73034 |
| Second Address | Edmond, OK 73034-6399 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/10/2005 |
| Last Update Date | 21/12/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 100116910A | (05) | OK |
| 108018103 | FIRSTCARE PROVIDER NUMBER (01) | TX |
| 115029404 | (05) | TX |
| 4060556 | HEALTHMARKET (01) | TX |
| D17349 | (02) | TX |
| P00231789 | RAIL ROAD RETIREMENT ID (01) | TX |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.