Healthcare Provider Details

I. General information

NPI: 1629013370
Provider Name (Legal Business Name): BING OBALDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WALLS DR
CLEBURNE TX
76033-4008
US

IV. Provider business mailing address

2119 LAKESHORE DR
CLEBURNE TX
76033-6966
US

V. Phone/Fax

Practice location:
  • Phone: 817-202-0355
  • Fax: 817-202-0009
Mailing address:
  • Phone: 817-202-0355
  • Fax: 817-202-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberF6057
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF6057
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberF6057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: