Provider Demographics
NPI:1508922618
Name:BALSAM, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BALSAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9536
Mailing Address - Country:US
Mailing Address - Phone:954-426-2898
Mailing Address - Fax:954-428-2769
Practice Address - Street 1:3275 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9536
Practice Address - Country:US
Practice Address - Phone:954-426-2898
Practice Address - Fax:954-428-2769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 22243207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254442300Medicaid
FLD93503Medicare UPIN
FL42612AMedicare ID - Type Unspecified