Provider Demographics
NPI:1609156405
Name:BALES, GREGORY (ATP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BALES
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4422
Mailing Address - Country:US
Mailing Address - Phone:210-949-1660
Mailing Address - Fax:210-949-0434
Practice Address - Street 1:7719 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4422
Practice Address - Country:US
Practice Address - Phone:210-949-1660
Practice Address - Fax:210-949-0434
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other