Healthcare Provider Details

I. General information

NPI: 1053470096
Provider Name (Legal Business Name): DANA S BAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

1316 OLD 63 S SUITE 102
COLUMBIA MO
65201-6092
US

V. Phone/Fax

Practice location:
  • Phone: 573-819-8000
  • Fax:
Mailing address:
  • Phone: 573-875-8838
  • Fax: 573-875-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number112228
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: