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Individual

GLEN C. BALCH

Active
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Individual

GLEN C. BALCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-118605
IL
2086X0206X
Surgical Oncology Physician
Primary
N4276
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036-118605
IL STATE LIC
IL
01
N4276
TX STATE MEDICAL LIC
TX
Enumeration date
06/26/2007
Last updated
01/07/2010
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