MEDICARE: DR. RANDOLPH CRAIG BALES M.D.

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	172V00000X	Community Health Worker	D8141	TX

General Provider Information

NPI Number	:	1184880841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH CRAIG BALES M.D.

Provider Business Mailing Address
First Line	:	2310 1/2 ATASCOCITA RD
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	281-459-8054
Fax Number	:	281-459-8040

Provider Business Practice Location Address
First Line	:	2310 1/2 ATASCOCITA RD
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	281-459-8054
Fax Number	:	281-459-8040

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	01/18/2026

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