Basic Information
| Provider Information | |||||||||
| NPI: | 1376701177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALZEN | ||||||||
| FirstName: | JACE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14100 SAN PEDRO AVE STE 412 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782322009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102818669 | ||||||||
| FaxNumber: | 2103145044 | ||||||||
| Practice Location | |||||||||
| Address1: | 11398 BANDERA RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102818669 | ||||||||
| FaxNumber: | 2103145044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P5508 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.