Organization
BALCONES IMAGING CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ROBERT MIREUR MD (TREASURER)
(512) 963-5360
Entity
Organization
Contact information
Practice address
1205 TAMRANAE CT., AUSTIN, TX 78746-0032
(512) 963-5360
Mailing address
PO BOX 301869, AUSTIN, TX 78703-0032
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191318801
—
TX
Enumeration date
08/03/2006
Last updated
11/08/2010
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