MEDICARE: JOHN ALLAN BALAZS DO

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	207Y00000X	Otolaryngology Physician	34002666	OH
2	207YS0123X	Facial Plastic Surgery Physician	34002666	OH
3	207YX0602X	Otolaryngic Allergy Physician	34002666	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	040012500	OTHER	OH	MEDICARE/RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700954526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ALLAN BALAZS DO

Provider Business Mailing Address
First Line	:	9279 ASH HOLLOW LANE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458
Country	:	US
Telephone Number	:	937-885-4933
Fax Number	:	937-885-6114

Provider Business Practice Location Address
First Line	:	425 W GRAND AVENUE
Second Line	:	SUITE 2003
City	:	DAYTON
State	:	OH
Zip	:	45405-4722
Country	:	US
Telephone Number	:	937-723-5888
Fax Number	:	937-226-0825

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/19/2008

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Directions to “ JOHN ALLAN BALAZS DO” Practice Location

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