Individual
MR. THOMAS BENJAMIN BALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6200
Mailing address
4631 TELLER AVE, STE 100, NEWPORT BEACH, CA 92660-8105
(949) 887-7187
(949) 476-3080
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA01031
RI
363A00000X
Physician Assistant
Primary
PA58355
CA
Other
Enumeration date
07/07/2018
Last updated
09/25/2020
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