Provider Demographics
NPI:1578544805
Name:BALSTAD, PAUL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:BALSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 S POTOMAC ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4528
Mailing Address - Country:US
Mailing Address - Phone:303-671-0000
Mailing Address - Fax:303-671-2879
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4528
Practice Address - Country:US
Practice Address - Phone:303-671-0000
Practice Address - Fax:303-671-2879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO13730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO01137207Medicaid
COCO5811Medicare ID - Type Unspecified
COCO01137207Medicaid