Healthcare Provider Details

I. General information

NPI: 1831173574
Provider Name (Legal Business Name): LOUIS B BALIZET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 PARKER BLVD SUITE 350
PUEBLO CO
81008-2212
US

IV. Provider business mailing address

7951 MAPLEWOOD AVE SUITE 300
GREENWOOD VILLAGE CO
80111
US

V. Phone/Fax

Practice location:
  • Phone: 719-296-6000
  • Fax: 719-545-1146
Mailing address:
  • Phone: 303-930-7800
  • Fax: 303-930-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number19357
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: