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NPI Code Detail

MEDICARE: DR. GARY ALLEN BALSTER M.D.

MEDICARE:  DR. GARY ALLEN BALSTER  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician35-05-1153-BOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881696300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY ALLEN BALSTER M.D.
Provider Business Mailing Address
First Line : 2218 S PATTERSON BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45409-1930
Country : US
Telephone Number : 937-299-1918
Fax Number : 937-299-4832
Provider Business Practice Location Address
First Line : 2218 S PATTERSON BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45409-1930
Country : US
Telephone Number : 937-299-1918
Fax Number : 937-299-4832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 03/07/2023

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Directions to “ DR. GARY ALLEN BALSTER M.D.” Practice Location

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