Provider Demographics
NPI:1518379031
Name:BAL, HEATHERANN ALISON (DO)
Entity Type:Individual
Prefix:
First Name:HEATHERANN
Middle Name:ALISON
Last Name:BAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHERANN
Other - Middle Name:ALISON
Other - Last Name:BRUNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:26900 N LAKE PLEASANT PKWY # 200
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1394
Mailing Address - Country:US
Mailing Address - Phone:623-561-3000
Mailing Address - Fax:623-561-3009
Practice Address - Street 1:26900 N LAKE PLEASANT PKWY # 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1394
Practice Address - Country:US
Practice Address - Phone:623-561-3000
Practice Address - Fax:623-561-3009
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007080207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7080OtherARIZONA LICENSE