Individual
GLENN MARK BALFOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
785 GRAND AVE STE 218, CARLSBAD, CA 92008-2371
(442) 500-8851
(442) 500-8681
Mailing address
5520 LOS ROBLES DR, CARLSBAD, CA 92008-4424
(760) 845-8884
(442) 500-8681
Taxonomy
Speciality
Code
Description
License number
State
2081P0004X
Spinal Cord Injury Medicine Physician
A86632
CA
2084N0400X
Neurology Physician
Primary
A86632
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BF428Z
MEDICARE PTAN
CA
Enumeration date
08/19/2006
Last updated
12/23/2024
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