Healthcare Provider Details

I. General information

NPI: 1477798213
Provider Name (Legal Business Name): DANIEL DAVID BALCOM C.P. L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4500 S LANCASTER RD B121
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD B121
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0553
  • Fax: 214-857-0549
Mailing address:
  • Phone: 214-857-0553
  • Fax: 214-857-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: