Provider Demographics
NPI:1740361583
Name:BALKMAN, DEBRA JANETTE (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANETTE
Last Name:BALKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 N MCMULLEN BOOTH RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3302
Mailing Address - Country:US
Mailing Address - Phone:727-725-5224
Mailing Address - Fax:727-799-2183
Practice Address - Street 1:2730 MCMULLEN BOOTH ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-725-5224
Practice Address - Fax:727-799-2183
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC242VMedicare PIN