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General NPI Number Information
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NPI Number | 1366993321
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Entity Type | Organization
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Legal Business Name | D BALDER MD PLLC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 11070 DAVID ST
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City | GULFPORT
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State | MS
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Zip | 39503-3852
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Country | US
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Telephone | 228-265-5945
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Fax | 228-284-1580
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Provider Business Mailing Address
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Address Line | 11070 DAVID ST
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City | GULFPORT
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State | MS
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Zip | 39503-3852
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Country | US
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Telephone | 228-265-5945
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Fax | 228-284-1580
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JODY MICHELLE MORAN
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Credential | BSN
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Telephone | 228-265-5945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042354MD
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21885
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License Number State | MS
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