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General NPI Number Information
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NPI Number | 1396107330
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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 | 03/28/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 15190 COMMUNITY RD
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City | GULFPORT
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State | MS
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Zip | 39503-3485
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Country | US
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Telephone | 228-265-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 15190 COMMUNITY RD
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City | GULFPORT
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State | MS
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Zip | 39503-3485
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SUSAN NUSSELL
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Credential |
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Telephone | 972-387-5800
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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 | 21885
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License Number State | MS
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