Provider Demographics
NPI:1083687594
Name:BALOUGH, BEN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:JAMES
Last Name:BALOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11625 ANGELIQUE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3815
Mailing Address - Country:US
Mailing Address - Phone:619-532-9604
Mailing Address - Fax:619-532-6088
Practice Address - Street 1:34520 BOB WILSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-2098
Practice Address - Country:US
Practice Address - Phone:619-532-9604
Practice Address - Fax:619-532-6088
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71198207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology