MEDICARE: JOHN DARRELL 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	34005564	OH

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	:	1962505933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DARRELL BALAZS DO

Provider Business Mailing Address
First Line	:	1290 CHISOLM TRL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458
Country	:	US
Telephone Number	:	937-886-9481
Fax Number	:

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	:	09/06/2006
Last Update Date	:	02/25/2020

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