Provider Demographics
NPI:1710986302
Name:REDDY, BAL T (MD)
Entity Type:Individual
Prefix:
First Name:BAL
Middle Name:T
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4813
Mailing Address - Country:US
Mailing Address - Phone:210-271-3204
Mailing Address - Fax:210-222-2761
Practice Address - Street 1:94 BRIGGS ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1221
Practice Address - Country:US
Practice Address - Phone:210-923-7736
Practice Address - Fax:210-923-7100
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-01-26
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Provider Licenses
StateLicense IDTaxonomies
TXG6601207RC0000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84856GOtherBCBS
TX060047791OtherRAILROAD MEDICARE
TX136714612Medicaid
TXP00948217OtherRAILROAD
TX8CU333OtherBCBS
TX80621JMedicare ID - Type Unspecified
TX136714612Medicaid
TXP00948217OtherRAILROAD
TX060047791OtherRAILROAD MEDICARE
TX8CU333OtherBCBS
C20929Medicare UPIN
TX136714612Medicaid