Healthcare Provider Details

I. General information

NPI: 1609804681
Provider Name (Legal Business Name): JASON BALETTE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 PINECROFT DR STE 250
WOODLANDS TX
77380-3279
US

IV. Provider business mailing address

9200 PINECROFT DR STE 250
WOODLANDS TX
77380-3279
US

V. Phone/Fax

Practice location:
  • Phone: 281-419-8400
  • Fax: 281-292-1972
Mailing address:
  • Phone: 281-419-8400
  • Fax: 281-292-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM2254
License Number StateTX

VIII. Authorized Official

Name: JASON BALETTE
Title or Position: DIRECTOR
Credential: MD
Phone: 281-419-8400