Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 8922 | SD |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD00034461 | WA |
N | 207RG0300X | Geriatric Medicine | MD00034461 | WA |
NPI | 1346570728 |
---|---|
Provider Name | Scott Andrew Balson |
First Address | Tacoma, WA 98405-1702 |
Second Address | Tacoma, WA 98405-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 14/01/2015 |