Individual
DAVID S BALLESTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 HARBOR BLVD, SUITE 102, PORT CHARLOTTE, FL 33952
(941) 629-7593
(941) 625-2751
Mailing address
2525 HARBOR BLVD, SUITE 102, PORT CHARLOTTE, FL 33952
(941) 629-7593
(941) 625-2751
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0044391
FL
208D00000X
General Practice Physician
ME0044391
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068916500
—
FL
Enumeration date
10/02/2006
Last updated
05/09/2008
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