Provider Demographics
NPI:1295064780
Name:R. BALA, M.D. P. A.
Entity type:Organization
Organization Name:R. BALA, M.D. P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-225-3006
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2268
Mailing Address - Country:US
Mailing Address - Phone:210-225-3006
Mailing Address - Fax:210-271-7755
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2268
Practice Address - Country:US
Practice Address - Phone:210-225-3006
Practice Address - Fax:210-271-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE49682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A5687Medicare PIN