Provider Demographics
NPI:1861442436
Name:BALFOUR, ERIC L (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:BALFOUR
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:PO BOX 4997
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-4997
Mailing Address - Country:US
Mailing Address - Phone:601-362-0600
Mailing Address - Fax:601-362-1186
Practice Address - Street 1:2969 CURRAN DR N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4121
Practice Address - Country:US
Practice Address - Phone:601-200-3070
Practice Address - Fax:601-200-3172
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS188962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00671542Medicaid
MO207209909Medicaid
AR83369OtherAR BCBS
MS000671542Medicaid
TN3329068Medicaid
MS1861442436OtherNPI
TN4108904OtherTN BCBS
MS00671542Medicaid
TN4108904OtherTN BCBS
MS1861442436OtherNPI