Provider Demographics
NPI:1275734881
Name:BALTAZAR, EFREN L (MD)
Entity Type:Individual
Prefix:
First Name:EFREN
Middle Name:L
Last Name:BALTAZAR
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 1:2309 TRESCOTT DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-487-1363
Mailing Address - Fax:800-672-1105
Practice Address - Street 1:2571 EXECUTIVE CENTER CIRCLE EAST
Practice Address - Street 2:HOWARD BUILDING DIVISION OF DISABILITY DETERMINATION
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32321
Practice Address - Country:US
Practice Address - Phone:850-487-1363
Practice Address - Fax:800-672-1105
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29436207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology