Provider Demographics
NPI:1881672285
Name:BHALOO, SALIM (DO)
Entity Type:Individual
Prefix:DR
First Name:SALIM
Middle Name:
Last Name:BHALOO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:
Practice Address - Street 1:4425 E US HIGHWAY 377 STE 104
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7475
Practice Address - Country:US
Practice Address - Phone:682-936-4081
Practice Address - Fax:817-570-0704
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1270207Y00000X, 207YX0602X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171536901Medicaid
TX8F0718OtherBCBS
TX8C6110Medicare PIN
TX8J2663Medicare PIN
TX8F0718OtherBCBS
TXP00407412Medicare PIN