Provider Demographics
NPI:1962505933
Name:BALAZS, JOHN DARRELL (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DARRELL
Last Name:BALAZS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 CHISOLM TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-886-9481
Mailing Address - Fax:
Practice Address - Street 1:425 W GRAND AVENUE
Practice Address - Street 2:SUITE 2003
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4722
Practice Address - Country:US
Practice Address - Phone:937-723-5888
Practice Address - Fax:937-226-0825
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005564207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382616Medicaid
OH0382616Medicaid
G39020Medicare UPIN