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General NPI Number Information
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NPI Number | 1922379379
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Entity Type | Organization
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Legal Business Name | JOHN S BALKNAP DPM PC
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 1716 E 12TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-3137
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Country | US
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Telephone | 541-296-1006
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Fax | 541-298-1613
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Provider Business Mailing Address
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Address Line | 1716 E 12TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-3137
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Country | US
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Telephone | 541-296-1006
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Fax | 541-298-1613
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Authorized Official
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Title or Position | BILLER
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Name | VERONICA LUNDMARK
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Credential |
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Telephone | 503-228-7106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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