Provider Demographics
NPI:1841792181
Name:BALANCE HORMONE PEORIA PLLC
Entity Type:Organization
Organization Name:BALANCE HORMONE PEORIA PLLC
Other - Org Name:BALANCE HORMONE PEORIA PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAFARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-487-1997
Mailing Address - Street 1:PO BOX 15782
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73155-5782
Mailing Address - Country:US
Mailing Address - Phone:405-455-3964
Mailing Address - Fax:210-800-9921
Practice Address - Street 1:15396 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5622
Practice Address - Country:US
Practice Address - Phone:632-487-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty