Provider Demographics
NPI:1376524603
Name:BALAZSY, JEFFREY E (MD, DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:BALAZSY
Suffix:
Gender:M
Credentials:MD, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122165 DEPT 2165
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2165
Mailing Address - Country:US
Mailing Address - Phone:337-494-4900
Mailing Address - Fax:337-494-4936
Practice Address - Street 1:1717 OAK PARK BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8990
Practice Address - Country:US
Practice Address - Phone:337-494-4900
Practice Address - Fax:337-494-4936
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312731207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91108OtherBCBS OF FLORIDA
LA818053OtherMEDICARE
MI4303052Medicaid
FLME92348OtherFLORIDA MEDICAL LICENSE
MIOM08420011Medicare ID - Type UnspecifiedWISCONSIN PHYSICIANS