Provider Demographics
NPI:1881696300
Name:BALSTER, GARY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:BALSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2218 S PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1930
Mailing Address - Country:US
Mailing Address - Phone:937-299-1918
Mailing Address - Fax:937-299-4832
Practice Address - Street 1:2218 S PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1930
Practice Address - Country:US
Practice Address - Phone:937-299-1918
Practice Address - Fax:937-299-4832
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-1153-B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0591248Medicaid
OH0591248Medicaid
OHBB1927322OtherDEA
OH0591248Medicaid
OHBA0600147Medicare PIN