Provider Demographics
NPI:1255387577
Name:BALUN, DONALD AUGUST JR (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:AUGUST
Last Name:BALUN
Suffix:JR
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 1:126 MISSOURI AVE
Mailing Address - Street 2:MCXP-CCS-CR
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8952
Mailing Address - Country:US
Mailing Address - Phone:573-596-0417
Mailing Address - Fax:573-596-0524
Practice Address - Street 1:1965 S FREMONT AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2201
Practice Address - Country:US
Practice Address - Phone:417-820-8180
Practice Address - Fax:417-820-8183
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215032-12084P0804X
MO20080262562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1255387577Medicaid
AR174243001Medicaid
MOP00635669OtherRR MEDICARE
431560263OtherTRICARE WEST
MO132680031Medicare PIN