Provider Demographics
NPI:1629013370
Name:OBALDO, BING (MD)
Entity Type:Individual
Prefix:DR
First Name:BING
Middle Name:
Last Name:OBALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-6966
Mailing Address - Country:US
Mailing Address - Phone:817-202-0355
Mailing Address - Fax:817-202-0009
Practice Address - Street 1:201 WALLS DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4008
Practice Address - Country:US
Practice Address - Phone:817-202-0355
Practice Address - Fax:817-202-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF60572085N0904X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114715902Medicaid
TX00LJ73Medicare PIN
TX114715902Medicaid