Provider Demographics
NPI:1194924399
Name:BALFANZ, PHILLIP EUGENE (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:EUGENE
Last Name:BALFANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4951
Mailing Address - Country:US
Mailing Address - Phone:830-538-0127
Mailing Address - Fax:830-521-4061
Practice Address - Street 1:123 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4951
Practice Address - Country:US
Practice Address - Phone:830-538-0127
Practice Address - Fax:830-521-4061
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN12572084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry