Provider Demographics
NPI:1093901639
Name:BALSTER, DOUGLAS ALLEN (MD PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:BALSTER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:SUMC-PEDS PHYSICIAN BILLING MC 5530
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2203
Mailing Address - Country:US
Mailing Address - Phone:650-498-7391
Mailing Address - Fax:650-725-7888
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:SUMC-PEDS PHYSICIAN BILLING MC 5530
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2203
Practice Address - Country:US
Practice Address - Phone:650-498-7391
Practice Address - Fax:650-725-7888
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA899302080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology