MEDICARE: ULISES BALTAZAR 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	2086S0129X	Vascular Surgery Physician	M1016	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
2	8G5887	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1124048954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ULISES BALTAZAR MD

Provider Business Mailing Address
First Line	:	PO BOX 3567
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77253-3567
Country	:	US
Telephone Number	:	713-790-5227
Fax Number	:	713-790-5505

Provider Business Practice Location Address
First Line	:	16605 SOUTHWEST FWY
Second Line	:	SUITE 505
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3501
Country	:	US
Telephone Number	:	281-240-8400
Fax Number	:	281-240-8405

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	12/04/2012

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Directions to “ ULISES BALTAZAR MD” Practice Location

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