Provider Demographics
NPI:1376524603
Name:BALAZSY, JEFFREY E (MD, DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:BALAZSY
Suffix:
Gender:M
Credentials:MD, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:801 E 6TH ST STE 602
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3645
Practice Address - Country:US
Practice Address - Phone:850-804-3850
Practice Address - Fax:850-804-7011
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92348207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91108OtherBCBS OF FLORIDA
FLME92348OtherFLORIDA MEDICAL LICENSE
MI4303052Medicaid
LA818053OtherMEDICARE
MIOM08420011Medicare ID - Type UnspecifiedWISCONSIN PHYSICIANS