Individual
ULISES BALTAZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16605 SOUTHWEST FWY, SUITE 505, SUGAR LAND, TX 77479-3501
(281) 240-8400
(281) 240-8405
Mailing address
PO BOX 3567, HOUSTON, TX 77253-3567
(713) 790-5227
(713) 790-5505
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
M1016
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178806902
—
TX
01
—
8G5887
BCBS
TX
Enumeration date
07/21/2006
Last updated
12/04/2012
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