Provider Demographics
NPI:1255325593
Name:BALES, KARRN ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KARRN
Middle Name:ELIZABETH
Last Name:BALES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KARRN
Other - Middle Name:ELIZABETH
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9523 LOYAL VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4942
Mailing Address - Country:US
Mailing Address - Phone:210-671-9556
Mailing Address - Fax:
Practice Address - Street 1:1616 TRUEMPER AVE
Practice Address - Street 2:
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-671-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001676A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine