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General NPI Number Information
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NPI Number | 1982726766
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Entity Type | Organization
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Legal Business Name | PETER E. BALSAM, MD, FACG
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 4987 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-7307
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Country | US
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Telephone | 321-264-3330
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Fax | 321-268-2286
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Provider Business Mailing Address
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Address Line | 4987 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-7307
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Country | US
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Telephone | 321-264-3330
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Fax | 321-268-2286
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER E. BALSAM
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Credential | M.D.
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Telephone | 321-264-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME46070
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License Number State | FL
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