Provider Demographics
NPI:1508940081
Name:BALKE, DEBRA LEE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:BALKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1320 LAS TABLAS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9711
Mailing Address - Country:US
Mailing Address - Phone:805-434-0960
Mailing Address - Fax:805-434-0978
Practice Address - Street 1:1320 LAS TABLAS RD
Practice Address - Street 2:SUITE E
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9711
Practice Address - Country:US
Practice Address - Phone:805-434-0960
Practice Address - Fax:805-434-0978
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG789002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology