Provider Demographics
NPI:1164556353
Name:BALCH, DAVID GR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GR
Last Name:BALCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1325 N. ROSE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3800
Mailing Address - Country:US
Mailing Address - Phone:714-961-5804
Mailing Address - Fax:714-961-5809
Practice Address - Street 1:4060 FOURTH AVE STE 440
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2183
Practice Address - Country:US
Practice Address - Phone:619-298-8891
Practice Address - Fax:619-298-4997
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ38051208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1421OtherMEDICAL LICENSE
CAGW921ZOtherPTAN
AZ38051OtherMEDICAL LICENSE
CAC55497OtherMEDICAL LICENSE
CAC55497OtherMEDICAL LICENSE
AZZ139538Medicare PIN