Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | ME 88514 | FL |
NPI | 1063400646 |
---|---|
Provider Name | Dr. Thomas C. Balshi |
First Address | Delray Beach, FL 33445-3800 |
Second Address | Delray Beach, FL 33445-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2005 |
Last Update Date | 12/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H69053 | (02) | FL |