Provider Demographics
NPI:1316289911
Name:BALENT, ALVAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALVAN
Middle Name:
Last Name:BALENT
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 1:333 LAS OLAS WAY
Mailing Address - Street 2:210
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2363
Mailing Address - Country:US
Mailing Address - Phone:954-294-5023
Mailing Address - Fax:
Practice Address - Street 1:333 LAS OLAS WAY
Practice Address - Street 2:210
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2363
Practice Address - Country:US
Practice Address - Phone:954-294-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME8066OtherMEDICAL LICENSE