Provider Demographics
NPI:1497926778
Name:BALTER, KEN W (PA C)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:W
Last Name:BALTER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:9800 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-302-1413
Mailing Address - Fax:206-302-1272
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
Practice Address - Country:US
Practice Address - Phone:206-302-1413
Practice Address - Fax:206-302-1272
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant