Individual
DR. EDWIN BALLELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4101 TOWN CTR BLVD, ORLANDO, FL 32837-5846
(407) 850-3497
(407) 851-0421
Mailing address
PO BOX 191, ROCKLAND, DE 19732-0191
(302) 651-4488
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME0076442
FL
208000000X
Pediatrics Physician
Primary
ME76442
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008475100
—
FL
Enumeration date
05/24/2006
Last updated
02/14/2014
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