Provider Demographics
NPI:1205818002
Name:BALAR, VASANT J (MD)
Entity type:Individual
Prefix:
First Name:VASANT
Middle Name:J
Last Name:BALAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14216 BRIARTHORN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3251
Mailing Address - Country:US
Mailing Address - Phone:813-960-3219
Mailing Address - Fax:813-969-2590
Practice Address - Street 1:224 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1625
Practice Address - Country:US
Practice Address - Phone:813-964-0111
Practice Address - Fax:813-969-2590
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0047371207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2313061OtherAETNA HMO
PA4418850OtherAETNA PPO
FL049107100Medicaid
PA4418850OtherAETNA PPO
FL30855Medicare ID - Type Unspecified