Organization
DAVID S BALLESTAS MD PA
Active
Other names
Medical Pavilion Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID S. BALLESTAS M.D. (OWNER/PRESIDENT)
(941) 629-7593
Entity
Organization
Contact information
Practice address
2525 HARBOR BLVD, SUITE 102, PORT CHARLOTTE, FL 33952-5317
(941) 629-7593
(941) 625-2751
Mailing address
2525 HARBOR BLVD, SUITE 102, PORT CHARLOTTE, FL 33952-5317
(941) 629-7593
(941) 625-2751
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H87694
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40389
MEDICARE GROUP NUMBER
FL
Enumeration date
09/20/2007
Last updated
05/09/2008
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