Individual
STEPHEN JAMES BALISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1397 WEIMER RD, TAOS, NM 87571-6253
(575) 758-8883
Mailing address
711 MAIN ST, WILBRAHAM, MA 01095-2631
(413) 636-8292
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD2024-1156
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2016
Last updated
04/24/2025
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