ICHABOD LAFAYETTE BALKCOM

TYLER, TX
NPI1922001817
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207Q00000X Family Medicine
(Licence: TX  J4701)
Enumeration Date2005-05-24
Last Update Date2021-08-05
Business Address
ICHABOD LAFAYETTE BALKCOM M.D.
10481 HWY 31 E
TYLER, TX 75705-2389
Phone number: 903-243-1110
Mailing Address
ICHABOD LAFAYETTE BALKCOM M.D.
10481 HWY 31 E
TYLER, TX 75705-2389
Phone number: 903-243-1110
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