Provider Demographics
NPI:1477798213
Name:BALCOM, DANIEL DAVID (CP LP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVID
Last Name:BALCOM
Suffix:
Gender:M
Credentials:CP LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:B121
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-0553
Mailing Address - Fax:214-857-0549
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:B121
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0553
Practice Address - Fax:214-857-0549
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX222224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist