Balkcom, Ichabod Lafayette

Balkcom, Ichabod Lafayette is an sole proprietor health care provider with primary practice located at 10481 Hwy 31 E , Tyler TX 75705-2389. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Balkcom, Ichabod Lafayette can be contacted via phone (903) 243-1110.

Contact Information

Primary practice address
10481 Hwy 31 E Tyler TX 75705-2389
Phone: (903) 243-1110
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X J4701 Texas

Profile Details

NPI number 1922001817
LBN Legal business name Balkcom, Ichabod Lafayette
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 24th, 2005
Last updated Aug 5th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922001817 NPPES
Texas MEDICAID 139946124

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