Provider Demographics
NPI:1972935385
Name:BALISE, TIMOTHY MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:BALISE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:705 MARKETPLACE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-1841
Mailing Address - Country:US
Mailing Address - Phone:314-808-3227
Mailing Address - Fax:
Practice Address - Street 1:705 MARKETPLACE PLZ STE 200
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-1841
Practice Address - Country:US
Practice Address - Phone:970-879-6663
Practice Address - Fax:970-871-1234
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT055.0031177363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical