Provider Demographics
NPI:1033199740
Name:BALCER, CONRAD S (DO)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:S
Last Name:BALCER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-556-5191
Mailing Address - Fax:573-761-4611
Practice Address - Street 1:1241 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-635-5264
Practice Address - Fax:573-761-4611
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3H14207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000010688OtherMCR GROUP
260021839OtherMEDICARE RAILROAD
153505OtherHEALTHLINK
MO243024726Medicaid
MOCP9089OtherRAILROAD GROUP
MO112014OtherBCBS
MO035010688Medicare PIN
MO000010688OtherMCR GROUP