Healthcare Provider Details

I. General information

NPI: 1063463776
Provider Name (Legal Business Name): BALCONES ANESTHESIOLOGISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OAKWOOD BLVD SUITE 202
ROUND ROCK TX
78681-4007
US

IV. Provider business mailing address

511 OAKWOOD BLVD SUITE 202
ROUND ROCK TX
78681-4007
US

V. Phone/Fax

Practice location:
  • Phone: 512-388-7088
  • Fax: 512-388-0699
Mailing address:
  • Phone: 512-388-7088
  • Fax: 512-388-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LANA H DENNY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 512-388-7088