Healthcare Provider Details

I. General information

NPI: 1881955508
Provider Name (Legal Business Name): ERIN BALZER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN LITTLEJOHN

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 N MUSTANG RD
MUSTANG OK
73064-7214
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-1800
  • Fax: 405-376-1856
Mailing address:
  • Phone: 405-376-1800
  • Fax: 405-376-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5350
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: