Provider Demographics
NPI:1295710028
Name:BALBO, JOHN M (MS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BALBO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1848
Mailing Address - Country:US
Mailing Address - Phone:254-298-2514
Mailing Address - Fax:254-791-2475
Practice Address - Street 1:1717 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1838
Practice Address - Country:US
Practice Address - Phone:254-298-2514
Practice Address - Fax:254-791-2475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50386231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX509466Medicare ID - Type Unspecified
TXS33171Medicare UPIN