Provider Demographics
NPI:1063633576
Name:BALFOUR, PELBRETON COLLYMORE JR (MD)
Entity Type:Individual
Prefix:
First Name:PELBRETON
Middle Name:COLLYMORE
Last Name:BALFOUR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 BAPTIST WAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2274
Mailing Address - Country:US
Mailing Address - Phone:448-227-6500
Mailing Address - Fax:448-227-6500
Practice Address - Street 1:125 BAPTIST WAY STE 3A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6500
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131374207RC0000X, 207RC0000X
NC2011-00311207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020721600Medicaid
AL209108Medicaid
FLME131374OtherFLORIDA MEDICAL LICENSE
ALMD.36331OtherALABAMA MEDICAL LICENSE