Provider Demographics
NPI:1376549287
Name:BALCH, KYLE C (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:C
Last Name:BALCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6717 NW 11TH PL
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4233
Mailing Address - Country:US
Mailing Address - Phone:352-331-7811
Mailing Address - Fax:352-331-3219
Practice Address - Street 1:6717 NW 11TH PLACE SUITE A
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4233
Practice Address - Country:US
Practice Address - Phone:352-331-7811
Practice Address - Fax:352-331-3219
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2008-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME74445207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43418OtherBLUE CROSS BLUE SHIELD
FL273924OtherAVMED
FLG68204Medicare UPIN
FL43418OtherBLUE CROSS BLUE SHIELD