Provider Demographics
NPI:1740210988
Name:BALVIN, SIMON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:BALVIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1924
Mailing Address - Country:US
Mailing Address - Phone:210-227-5572
Mailing Address - Fax:210-227-5575
Practice Address - Street 1:526 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1924
Practice Address - Country:US
Practice Address - Phone:210-227-5572
Practice Address - Fax:210-227-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0496213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R318Medicare ID - Type Unspecified
TX5243090001Medicare NSC
TXT12059Medicare UPIN