Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO0001925 | FL |
Y | 222Z00000X | Podiatrist | PO0001925 | FL |
NPI | 1063520617 |
---|---|
Provider Name | Dr. Robert C Balandis |
First Address | Davie, FL 33324 |
Second Address | Davie, FL 33324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053167700 | (05) | FL |
T96230 | (02) |