Provider Demographics
NPI:1265303762
Name:BALTHAZAR, JAMES SR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BALTHAZAR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 GREEN WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8866
Mailing Address - Country:US
Mailing Address - Phone:318-294-2913
Mailing Address - Fax:
Practice Address - Street 1:1108 GREEN WOOD CIR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8866
Practice Address - Country:US
Practice Address - Phone:318-294-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker