Brian Russell Balcolm IDMT

NPI 1205110368 - Military Health Care Provider - 1710I1003X

NPI Details
NPI 1205110368
Gender Male
Enumeration Date 10/06/2011
Last Updated 07/31/2013
Entity Type Individual
Active Over 5 years ago
Practice Location
4099 FORREST RUN CIR
VALDOSTA GA, 31605-6538, US
Phone (574) 855-7051
Fax
Business Location
4099 FORREST RUN CIR
VALDOSTA GA, 31605-6538, US
Phone (574) 855-7051
Fax
Toxanomy
Taxonomy Code 1710I1003X
License State
License Number
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According to our database, Brian Russell Balcolm IDMT NPI is 1205110368, taxonomy code is 1710I1003X Brian Russell Balcolm IDMT physically located at 4099 Forrest Run Cir, Valdosta GA, 31605-6538. NPI Number Brian Russell Balcolm IDMT has the Individual type.

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1205110368 NPI number is provided on an as is basis without warranty of any kind. 1205110368 is maintained by the National Plan & Provider Enumeration System. The contents of Brian Russell Balcolm IDMT are for informational purposes only.