Provider Demographics
NPI:1467592121
Name:BALUCH, WILLIAM M (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:BALUCH
Suffix:
Gender:M
Credentials:PA
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 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:9800 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2152
Practice Address - Country:US
Practice Address - Phone:206-302-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8356594Medicaid
WAG8872231Medicare PIN
WAP47224Medicare UPIN
WA8356594Medicaid
WAGAB26247Medicare PIN
WAG8806583Medicare PIN
WAG8806585Medicare PIN
WAG8806591Medicare PIN
WA970024261Medicare PIN