Provider Demographics
NPI:1518254481
Name:BALIN, SAMUEL JACKSON (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JACKSON
Last Name:BALIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BELTLINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1091
Mailing Address - Country:US
Mailing Address - Phone:541-344-4168
Mailing Address - Fax:458-201-8510
Practice Address - Street 1:860 BELTLINE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1091
Practice Address - Country:US
Practice Address - Phone:541-344-4168
Practice Address - Fax:458-201-8510
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD197986207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology