Individual
DR. CARLOS BAZALDUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 WEST HIGHWAY 114, SUITE 200, GRAPEVINE, TX 76051
(817) 416-7214
(817) 416-4694
Mailing address
2020 W HIGHWAY 114, SUITE 200, GRAPEVINE, TX 76051-8649
(817) 416-7214
(817) 416-4694
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
J3981
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045647703
—
TX
01
—
8B5300
BCBS
TX
Enumeration date
06/30/2006
Last updated
07/26/2010
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