Provider Demographics
NPI:1881654820
Name:BALLANCE, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:BALLANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1075 N CURTIS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1300
Mailing Address - Country:US
Mailing Address - Phone:208-377-5166
Mailing Address - Fax:208-375-0599
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-377-5166
Practice Address - Fax:208-375-0599
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM7480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1115400Medicare ID - Type Unspecified
G77852Medicare UPIN