Individual
DR. ROBERTO ALEJANDRO BALLIVIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240-6524
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N6158
TX
208D00000X
General Practice Physician
N6158
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
348930401
—
TX
01
—
8FJ673
BCBS
TX
01
—
P01741026
RR MEDICARE
TX
Enumeration date
07/28/2010
Last updated
06/15/2021
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