Provider Demographics
NPI:1518206507
Name:GREGORY M. BALOURDAS, M.D., INC.
Entity Type:Organization
Organization Name:GREGORY M. BALOURDAS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALOURDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-291-2430
Mailing Address - Street 1:4101 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1342
Mailing Address - Country:US
Mailing Address - Phone:619-291-2430
Mailing Address - Fax:619-291-4048
Practice Address - Street 1:4101 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1342
Practice Address - Country:US
Practice Address - Phone:619-291-2430
Practice Address - Fax:619-291-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51351207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty