Provider Demographics
NPI:1821355868
Name:BALDERAMOS, MICHAEL JOE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOE
Last Name:BALDERAMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:907 EUREKA ST STE B
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5880
Mailing Address - Country:US
Mailing Address - Phone:817-598-8150
Mailing Address - Fax:817-599-4902
Practice Address - Street 1:907 EUREKA ST STE B
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5880
Practice Address - Country:US
Practice Address - Phone:817-598-8150
Practice Address - Fax:817-599-4902
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3999207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine