MEDICARE: DR. BING OBALDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0904X	Nuclear Radiology Physician	F6057	TX
2	2085R0202X	Diagnostic Radiology Physician	F6057	TX
3	2085R0204X	Vascular & Interventional Radiology Physician	F6057	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629013370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BING OBALDO MD

Provider Business Mailing Address
First Line	:	2119 LAKESHORE DR
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-6966
Country	:	US
Telephone Number	:	817-202-0355
Fax Number	:	817-202-0009

Provider Business Practice Location Address
First Line	:	201 WALLS DR
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76033-4008
Country	:	US
Telephone Number	:	817-202-0355
Fax Number	:	817-202-0009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	12/17/2008

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Directions to “ DR. BING OBALDO MD” Practice Location

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