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General NPI Number Information
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NPI Number | 1578658043
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Entity Type | Individual
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Provider Name | LARRY THOMAS BALENTINE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 259 HUNT RD
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City | PORT ANGELES
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State | WA
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Zip | 98363-9657
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Country | US
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Telephone | 360-525-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 259 HUNT RD
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City | PORT ANGELES
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State | WA
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Zip | 98363-9657
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Country | US
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Telephone | 360-525-4646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD 60036029
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60036029
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License Number State | WA
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