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NPI Code Detail

MEDICARE: JEFFREY TYLER BALKENBUSH MD

MEDICARE: JEFFREY TYLER BALKENBUSH 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
1207Q00000XFamily Medicine Physician43195OK
2390200000XStudent in an Organized Health Care Education/Training Program
3207Q00000XFamily Medicine Physician2025-02357NC

General Provider Information

NPI Number : 1376122028
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY TYLER BALKENBUSH MD
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 405-271-8818
Fax Number :
Provider Business Practice Location Address
First Line : 9101 MONROE RD STE 155
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-2467
Country : US
Telephone Number : 704-384-1260
Fax Number : 704-384-1289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2021
Last Update Date : 08/11/2025

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Directions to “ JEFFREY TYLER BALKENBUSH MD” Practice Location

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