Eldridge E Baltazar, L/ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2397 Issued in NC

Practice address

2416 Keerans St 82ND 3BCT
Fort Bragg, NC 28310-7243

Phone

(910) 984-9119

NPI assigned

Apr 7, 2022

Last updated

Jul 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1376285767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 STOBHILL LN",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275407243",
            "telephone_number": "910-297-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 KEERANS ST 82ND 3BCT",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283107243",
            "telephone_number": "910-984-9119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 Stobhill Ln",
            "address_purpose": "LOCATION",
            "city": "Holly Springs",
            "state": "NC",
            "postal_code": "275407243",
            "country_code": "US",
            "telephone_number": "910-297-2115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALTAZAR",
        "first_name": "ELDRIDGE",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "L/ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-07",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "2397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Bianca Ballantyne, PH.D.
• Heather L Ballard, DPT, MOT
• Peter Kjell Ballard, M.D.
• Theodore J Ballard, DPT
• Cory Duane Ballentine
• Louie Morgan Banks III, PHD
• George Allen Barbee, PA-C
• Barber DME Supply Group
• George Russell Barber, DMD
• James Barbosa, PA-C

• Athletic Trainer in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Athletic Trainer in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.