| Na | |
|
4987 S Washington Ave Titusville FL 32780-7307 | |
| (321) 264-3330 | |
| (321) 268-2286 |
| Full Name | Na |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 4987 S Washington Ave, Titusville, Florida |
| Authorized Official Name and Position | Peter E. Balsam (OWNER) |
| Authorized Official Contact | 3212643330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 4987 S Washington Ave Titusville FL 32780-7307 Ph: (321) 264-3330 | Na 4987 S Washington Ave Titusville FL 32780-7307 Ph: (321) 264-3330 |
| NPI Number | 1982726766 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 01/27/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982726766 | NPI | - | NPPES |
| 46070 | Other | FL | MED LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | ME46070 (Florida) | Primary |
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