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General NPI Number Information
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NPI Number | 1760691927
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Entity Type | Individual
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Provider Name | JORDAN LEE BALES M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 3107 EDGAR BROWN DR
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City | WEST ORANGE
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State | TX
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Zip | 77630-5347
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Country | US
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Telephone | 409-920-4470
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Fax | 409-920-4475
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Provider Business Mailing Address
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Address Line | 3905 PRINE LN
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City | DEER PARK
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State | TX
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Zip | 77536-2030
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Country | US
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Telephone | 541-220-1268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD16885
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 61140-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD29300
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 26695
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License Number State | NE
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10934
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License Number State | ND
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Taxonomy #6
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 58995
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | P9153
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License Number State | TX
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