Balcome, Charles Douglas

Balcome, Charles Douglas is an individual health care provider with primary practice located at 16601 N 40Th St Ste 204 , Phoenix AZ 85032-3356. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as his primary health care specialty. Balcome, Charles Douglas can be contacted via phone (602) 633-3721.

Contact Information

Primary practice address
16601 N 40Th St Ste 204 Phoenix AZ 85032-3356
Phone: (602) 633-3721
Fax: (602) 595-1127
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X AP11604 Arizona

Profile Details

NPI number 1376027557
LBN Legal business name Balcome, Charles Douglas
Credentials ACNP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 24th, 2018
Last updated Oct 20th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376027557 NPPES
Arizona MEDICAID 443489

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