Provider Demographics
NPI:1760967541
Name:BALOGUN, GREGORY
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:BALOGUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10990 SWITZER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1363
Mailing Address - Country:US
Mailing Address - Phone:214-221-0277
Mailing Address - Fax:214-221-0858
Practice Address - Street 1:10990 SWITZER AVE STE 301
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1363
Practice Address - Country:US
Practice Address - Phone:214-221-0277
Practice Address - Fax:214-221-0858
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX463819088OtherPERSONAL ASSISTANCE SERVICE