Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 34002666 | OH |
N | 207YS0123X | Facial Plastic Surgeon | 34002666 | OH |
NPI | 1700954526 |
---|---|
Provider Name | John Allan Balazs |
First Address | Centerville, OH 45458 |
Second Address | Dayton, OH 45405-4722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 19/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0383446 | (05) | OH |
040012500 | MEDICARE/RAILROAD (01) | OH |
A77987 | (02) |