| Doctor Name: | DAVID S BALLESTAS |
| NPI Number: | 1609969419 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME0044391 |
| Business Practice Address: | 2525 Harbor Blvd Suite 102 Port Charlotte, FL - 33952 |
| Business Phone Number: | 9416297593 |
| Business Fax Number: | 9416252751 |
| Mailing Address: | 2525 Harbor Blvd, Suite 102 PORT CHARLOTTE |
| State: | FL |
| Postal Code: | 33952 |
| Phone Number: | 9416297593 |
| Fax Number: | 9416252751 |
| NPI Enumeration Date: | 10/02/2006 |
| NPI Last Update Date: | 05/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0044391 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |