Individual
DR. CONRAD S. BALCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 761-4611
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-5191
(573) 761-4611
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R3H14
MO
207RC0000X
Cardiovascular Disease Physician
Primary
R3H14
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010688
MCR GROUP
MO
01
—
112014
BCBS
MO
01
—
153505
HEALTHLINK
—
05
—
243024726
—
MO
01
—
260021839
MEDICARE RAILROAD
—
01
—
CP9089
RAILROAD GROUP
MO
Enumeration date
01/19/2006
Last updated
07/31/2008
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