MEDICARE: PAUL JAMES BALZER JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD11465	ME

General Provider Information

NPI Number	:	1295719391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JAMES BALZER JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 1638
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12201-1638
Country	:	US
Telephone Number	:	207-777-4111
Fax Number	:	207-783-6660

Provider Business Practice Location Address
First Line	:	15 GRACELAWN RD
Second Line	:	SUITE 103
City	:	AUBURN
State	:	ME
Zip	:	04210-6334
Country	:	US
Telephone Number	:	207-330-3950
Fax Number	:	207-330-3950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/15/2013

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