Individual
MR. CHARLES DOUGLAS BALCOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
16601 N 40TH ST STE 204, PHOENIX, AZ 85032-3356
(602) 633-3721
(602) 595-1127
Mailing address
22331 N 79TH DR, PEORIA, AZ 85383-2157
(602) 335-9374
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP11604
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
443489
—
AZ
Enumeration date
09/24/2018
Last updated
10/20/2021
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