Basic Information
| Provider Information | |||||||||
| NPI: | 1518922350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALTZER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88MDG/SGHJ 4881 SUGAR MAPLE DRIVE | ||||||||
| Address2: | |||||||||
| City: | WRIGHT PATTERSON AIR FORCE BASE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372578718 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 88MDG/SGHJ 4881 SUGAR MAPLE DRIVE | ||||||||
| Address2: | |||||||||
| City: | WRIGHT PATTERSON AIR FORCE BASE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372578718 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.142368 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 13461 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.