Healthcare Provider Details

I. General information

NPI: 1437210127
Provider Name (Legal Business Name): EDUARDO BALSERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST MS-417
DUNEDIN FL
34698-5848
US

IV. Provider business mailing address

PO BOX 552154
TAMPA FL
33655-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-6635
  • Fax:
Mailing address:
  • Phone: 727-734-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME45680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: