Provider Demographics
NPI:1104912476
Name:BALMER, JOHN E JR (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:BALMER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434-0211
Mailing Address - Country:US
Mailing Address - Phone:814-654-7334
Mailing Address - Fax:814-654-7553
Practice Address - Street 1:132 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434-0211
Practice Address - Country:US
Practice Address - Phone:814-654-7334
Practice Address - Fax:814-654-7553
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007522L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001511070Medicaid
AL104643OtherUNISON
PAF64313Medicare UPIN
108551QSEMedicare ID - Type Unspecified