Provider Demographics
NPI:1700954526
Name:BALAZS, JOHN ALLAN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLAN
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 1:9279 ASH HOLLOW LANE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-885-4933
Mailing Address - Fax:937-885-6114
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:2006-12-01
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002666207Y00000X, 207YS0123X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0383446Medicaid
OH040012500OtherMEDICARE/RAILROAD
A77987Medicare UPIN
OH040012500OtherMEDICARE/RAILROAD