Provider Demographics
NPI:1710083555
Name:BALSON, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:BALSON
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 1:12959 PALMS WEST DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4940
Mailing Address - Country:US
Mailing Address - Phone:561-790-2258
Mailing Address - Fax:561-791-7489
Practice Address - Street 1:12959 PALMS WEST DR STE 230
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4940
Practice Address - Country:US
Practice Address - Phone:561-790-2258
Practice Address - Fax:561-791-7489
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151493207KA0200X
FLME132466207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3164918Medicaid
MA21401OtherNEIGHBORHOOD HEALTH PLAN
MAAA9876OtherHARVARD PILGRIM
MAJ17132OtherBLUE CROSS BLUE SHIELD
MA151493OtherTUFTS
MAJ17132Medicare ID - Type UnspecifiedMEDICARE
MA21401OtherNEIGHBORHOOD HEALTH PLAN