MEDICARE: SAFO & BALTAZAR ANESTHESIA ASSOCIATES, LLP

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1659421329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFO & BALTAZAR ANESTHESIA ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	3200 BROADWAY BLVD
Second Line	:	STE 130
City	:	GARLAND
State	:	TX
Zip	:	75043-1573
Country	:	US
Telephone Number	:	972-840-2804
Fax Number	:

Provider Business Practice Location Address
First Line	:	7989 W VIRGINIA DR
Second Line	:	STE 102
City	:	DALLAS
State	:	TX
Zip	:	75237-3765
Country	:	US
Telephone Number	:	972-296-3700
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	DR. ROMEO C BALTAZAR
Credential	:	MD
Telephone Number	:	214-750-0598

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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