Individual
SUBRAMANIAM BALACHANDRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1007 S WILLIAM ST, ATLANTA, TX 75551-3245
(903) 799-3326
Mailing address
PO BOX 797, LANCASTER, TX 75146-0797
(254) 694-5092
(254) 694-7039
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G0656
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1365207-01
—
TX
05
—
142587001
—
AR
01
—
15AR
BLUE CROSS/BLUE SHIELD
TX
05
—
1675661
—
LA
Enumeration date
06/26/2005
Last updated
05/21/2010
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