Provider Demographics
NPI:1952398976
Name:BALD, CHRISTOPHER E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:BALD
Suffix:
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 1:2120 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7765
Mailing Address - Country:US
Mailing Address - Phone:352-732-5042
Mailing Address - Fax:352-732-6031
Practice Address - Street 1:2120 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7765
Practice Address - Country:US
Practice Address - Phone:352-732-5042
Practice Address - Fax:352-732-6031
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030504207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040000058OtherRAILROAD MEDICARE NUMBER
FL198188OtherHEALTHEASE-WELLCARE
FL4544150OtherAETNA PROVIDER NUMBER
FL065842100Medicaid
FL42150OtherBLUE CROSS PROVIDER #
FL101057OtherAVMED PROVIDER NUMBER
FL42150OtherBLUE CROSS PROVIDER #
FL040000058OtherRAILROAD MEDICARE NUMBER