Provider Demographics
NPI:1831377399
Name:BALA, JENNIFER CALARA (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CALARA
Last Name:BALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1711
Mailing Address - Country:US
Mailing Address - Phone:941-746-5840
Mailing Address - Fax:941-745-3591
Practice Address - Street 1:3701 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1711
Practice Address - Country:US
Practice Address - Phone:941-746-5840
Practice Address - Fax:941-745-3591
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055173207RN0300X
FLME94266207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6537YMedicare PIN