MEDICARE: RAJARAM BALA 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	2086S0122X	Plastic and Reconstructive Surgery Physician	E4968	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

General Provider Information

NPI Number	:	1457459919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJARAM BALA MD

Provider Business Mailing Address
First Line	:	343 W HOUSTON ST
Second Line	:	SUITE 1002
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2268
Country	:	US
Telephone Number	:	210-225-3006
Fax Number	:	210-271-7755

Provider Business Practice Location Address
First Line	:	343 W HOUSTON STREET
Second Line	:	SUITE 1002
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2268
Country	:	US
Telephone Number	:	210-225-3006
Fax Number	:	210-271-7755

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/07/2010

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