Healthcare Provider Details

I. General information

NPI: 1700633500
Provider Name (Legal Business Name): RICHARD ALLEN BALBIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 LA HACIENDA DR
INDIAN ROCKS BEACH FL
33785-3715
US

IV. Provider business mailing address

358 LA HACIENDA DR
INDIAN ROCKS BEACH FL
33785-3715
US

V. Phone/Fax

Practice location:
  • Phone: 727-748-6338
  • Fax:
Mailing address:
  • Phone: 727-748-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS4274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: