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Individual

MR. GANAPATHY BALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1315 S PUEBLO BLVD, PUEBLO, CO 81005-2191
(719) 561-9757
(719) 561-9764
Mailing address
1315 S PUEBLO BLVD, PUEBLO, CO 81005-2191
(719) 561-9757
(719) 561-9764

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
36577
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01365774
CO
Enumeration date
06/21/2005
Last updated
12/04/2015
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