Individual
GLEN C. BALCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5323 HARRY HINES BLVD, UNIVERSITY OF TEXAS SOUTHWESTERN UNIVERSITY, DALLAS, TX 75390-8548
(214) 648-5870
(214) 648-1118
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 648-5870
(214) 648-1118
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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