MEDICARE: KATHARINE J BALBUENA 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	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0030QD	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649239005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHARINE J BALBUENA MD

Provider Business Mailing Address
First Line	:	PO DRAWER D
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75671
Country	:	US
Telephone Number	:	903-927-6640
Fax Number	:	903-927-6643

Provider Business Practice Location Address
First Line	:	811 SOUTH WASHINGTON
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672
Country	:	US
Telephone Number	:	903-927-6640
Fax Number	:	903-927-6643

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATHARINE J BALBUENA
Credential	:	MD
Telephone Number	:	903-927-6640

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	06/26/2009

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