Individual
DR. GILBERT BAZALDUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
614B HWY 76, WHITE HOUSE, TN 37188
(615) 672-3767
(615) 672-1118
Mailing address
PO BOX 328, WHITE HOUSE, TN 37188-0328
(615) 672-3767
(615) 672-1118
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD012487
TN
207R00000X
Internal Medicine Physician
Primary
MD12487
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003132265
BLUE CROSS
TN
01
—
44D0307958
CLIA
TN
Enumeration date
12/20/2006
Last updated
01/11/2011
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